Provider Demographics
NPI:1215626619
Name:CLODFELTER, TAMMY DEE (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DEE
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3437
Mailing Address - Country:US
Mailing Address - Phone:605-659-0908
Mailing Address - Fax:
Practice Address - Street 1:1559 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3437
Practice Address - Country:US
Practice Address - Phone:605-659-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20230001663103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool