Provider Demographics
NPI:1851420749
Name:CLARKSON, WANDA E (LPC)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:E
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1137
Mailing Address - Country:US
Mailing Address - Phone:541-734-9395
Mailing Address - Fax:541-857-9076
Practice Address - Street 1:714 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6712
Practice Address - Country:US
Practice Address - Phone:541-734-9395
Practice Address - Fax:541-857-9076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health