Provider Demographics
NPI:1336331743
Name:CLEM, SUDIE M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUDIE
Middle Name:M
Last Name:CLEM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BYPASS 225
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-1154
Mailing Address - Country:US
Mailing Address - Phone:864-344-3484
Mailing Address - Fax:864-977-3480
Practice Address - Street 1:112 BYPASS 225
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-344-3484
Practice Address - Fax:864-977-3480
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1112Medicaid
SCSW1112Medicaid