Provider Demographics
NPI:1215824834
Name:CLAYTON, CARLY THERESA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:THERESA
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 JUNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-2310
Mailing Address - Country:US
Mailing Address - Phone:267-978-0013
Mailing Address - Fax:
Practice Address - Street 1:2080 CABOT BLVD W STE 200
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1813
Practice Address - Country:US
Practice Address - Phone:855-720-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL018474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist