Basic Information
| Provider Information | |||||||||
| NPI: | 1912942053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | CLARENCE | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 SWIFT BLVD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993523524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099431880 | ||||||||
| FaxNumber: | 5099433443 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 PLAZA WA | ||||||||
| Address2: | FLOOR 4 | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216450 | ||||||||
| FaxNumber: | 5092216230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD00014637 | WA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1023720 | 05 | WA | MEDICAID |