Provider Demographics
NPI:1861821555
Name:CLAYTON, DOROTHEA (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
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 1:218 E 7615 S
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2626
Mailing Address - Country:US
Mailing Address - Phone:801-712-0571
Mailing Address - Fax:801-561-4776
Practice Address - Street 1:3940 W 4100 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-5450
Practice Address - Country:US
Practice Address - Phone:801-712-0571
Practice Address - Fax:801-561-4776
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT356424-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical