Provider Demographics
NPI:1609408475
Name:CLERKLEY, CLAIRE ALLISON
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:ALLISON
Last Name:CLERKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3458
Mailing Address - Country:US
Mailing Address - Phone:260-482-9125
Mailing Address - Fax:260-481-2838
Practice Address - Street 1:1909 CAREW ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4707
Practice Address - Country:US
Practice Address - Phone:260-481-2800
Practice Address - Fax:260-481-2838
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health