Individual
CLIFFORD K STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 236-2931
Mailing address
1071 GOLDENROD DR, APPLETON, WI 54914-8892
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2057-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2057-057
PSYCHOGIST NO.
WI
05
—
39148100
—
WI
Enumeration date
03/30/2007
Last updated
07/08/2007
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