Provider Demographics
NPI:1003863531
Name:SANKEY, CLAYTON DAVID (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:DAVID
Last Name:SANKEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-2523
Mailing Address - Country:US
Mailing Address - Phone:651-770-0355
Mailing Address - Fax:651-770-0529
Practice Address - Street 1:2510 7TH AVE E
Practice Address - Street 2:SUITE #101
Practice Address - City:NORTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3033
Practice Address - Country:US
Practice Address - Phone:651-770-0355
Practice Address - Fax:651-770-0529
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN000971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00097OtherSOCIAL WORK LICENSE NUMBE