Provider Demographics
NPI:1033735352
Name:CLAYTON, SHELLEY RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ESSIE DAVISON DR
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2915
Mailing Address - Country:US
Mailing Address - Phone:712-542-2176
Mailing Address - Fax:
Practice Address - Street 1:400 W GLENN MILLER DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2963
Practice Address - Country:US
Practice Address - Phone:712-542-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220340731041C0700X
IA1001911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507544203Medicaid