Individual
LISA CLAYTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
1000 HIGHWAY 12, HETTINGER, ND 58639-7530
(701) 567-6045
(701) 567-6361
Mailing address
208 LAKEVIEW DR, HETTINGER, ND 58639-9500
(701) 567-2241
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
759
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18864
BLUE CROSS OF NORTH DAKOT
ND
Enumeration date
10/03/2006
Last updated
07/08/2007
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