Provider Demographics
NPI:1720585508
Name:CLAYTON, DAWN (LISW-S)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 VIRA RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4252
Mailing Address - Country:US
Mailing Address - Phone:330-814-7033
Mailing Address - Fax:
Practice Address - Street 1:3690 VIRA RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4252
Practice Address - Country:US
Practice Address - Phone:330-814-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1451211-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical