Provider Demographics
NPI:1265196877
Name:STANTON MCCLURE, KATELYN (LSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:STANTON MCCLURE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3936
Mailing Address - Country:US
Mailing Address - Phone:440-888-0300
Mailing Address - Fax:
Practice Address - Street 1:5955 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3936
Practice Address - Country:US
Practice Address - Phone:440-888-0300
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-21-190723106S00000X
OHS.2410953104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician