Provider Demographics
NPI:1942657804
Name:STANTON, CLAIRE (MA)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 NW OVERTON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1618
Mailing Address - Country:US
Mailing Address - Phone:509-842-2840
Mailing Address - Fax:
Practice Address - Street 1:1977 NW OVERTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1618
Practice Address - Country:US
Practice Address - Phone:509-842-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#3938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health