Provider Demographics
NPI:1821601766
Name:ALLIDA, CLARA ELAINE
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ELAINE
Last Name:ALLIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:ELAINE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0983
Mailing Address - Country:US
Mailing Address - Phone:360-628-6010
Mailing Address - Fax:
Practice Address - Street 1:3443 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3091
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1821601766106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician