Provider Demographics
NPI:1982476610
Name:CLAYTON, TERRI R
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:R
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4478 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5420
Mailing Address - Country:US
Mailing Address - Phone:414-899-3030
Mailing Address - Fax:
Practice Address - Street 1:303 CARRUTHERS ST
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-3474
Practice Address - Country:US
Practice Address - Phone:414-899-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver