Provider Demographics
NPI:1023097185
Name:CLAYTON D. SANKEY LICSW, LLC
Entity type:Organization
Organization Name:CLAYTON D. SANKEY LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:651-770-0355
Mailing Address - Street 1:6484 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-2523
Mailing Address - Country:US
Mailing Address - Phone:651-770-0355
Mailing Address - Fax:651-429-2988
Practice Address - Street 1:2127 COUNTY ROAD D E STE A100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5350
Practice Address - Country:US
Practice Address - Phone:651-770-0355
Practice Address - Fax:651-770-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN000971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN454048400Medicaid
MN00097OtherLICSW LICENSE #