Provider Demographics
NPI:1598507519
Name:CLARKSON, EMILY KATE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATE
Last Name:CLARKSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 ALDRICH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3528
Mailing Address - Country:US
Mailing Address - Phone:507-696-1150
Mailing Address - Fax:
Practice Address - Street 1:441 OLD HIGHWAY 8 NW STE 204
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3305
Practice Address - Country:US
Practice Address - Phone:612-778-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist