Provider Demographics
NPI:1821564550
Name:CLAVIJO, MIKAYLA N
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:N
Last Name:CLAVIJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2837
Mailing Address - Country:US
Mailing Address - Phone:402-916-4539
Mailing Address - Fax:402-403-5857
Practice Address - Street 1:8610 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3377
Practice Address - Country:US
Practice Address - Phone:402-916-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician