Provider Demographics
NPI:1184400145
Name:CLAYTON, MATTHEW C (MSW, LSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9853 N ALPINE RD # 202
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1681
Mailing Address - Country:US
Mailing Address - Phone:815-997-6836
Mailing Address - Fax:779-552-8443
Practice Address - Street 1:8038 MACINTOSH LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5336
Practice Address - Country:US
Practice Address - Phone:815-997-6836
Practice Address - Fax:779-552-8443
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.111249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty