Provider Demographics
NPI:1356101216
Name:KIRKPATRICK, CLARENCE
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E 214TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1950
Mailing Address - Country:US
Mailing Address - Phone:216-571-8797
Mailing Address - Fax:
Practice Address - Street 1:323 E 214TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1950
Practice Address - Country:US
Practice Address - Phone:216-571-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities