Provider Demographics
NPI:1861836066
Name:CLAYTON, CANDYCE (PHD, MS, LAC)
Entity Type:Individual
Prefix:DR
First Name:CANDYCE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHD, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2064
Mailing Address - Country:US
Mailing Address - Phone:612-817-9456
Mailing Address - Fax:
Practice Address - Street 1:1384 CLARENCE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2064
Practice Address - Country:US
Practice Address - Phone:612-817-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1545171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist