Provider Demographics
NPI:1457592040
Name:CLAFTON, WILLIAM G (LP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:CLAFTON
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1755 OLD WEST MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2088
Mailing Address - Country:US
Mailing Address - Phone:651-385-9131
Mailing Address - Fax:651-385-9141
Practice Address - Street 1:1755 OLD WEST MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2088
Practice Address - Country:US
Practice Address - Phone:651-385-9131
Practice Address - Fax:651-385-9141
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4994103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist