Provider Demographics
NPI:1336376037
Name:CLAY, KARENELISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARENELISE
Middle Name:
Last Name:CLAY
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 1:830 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4948
Mailing Address - Country:US
Mailing Address - Phone:630-484-1950
Mailing Address - Fax:630-985-6483
Practice Address - Street 1:830 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4948
Practice Address - Country:US
Practice Address - Phone:630-484-1950
Practice Address - Fax:630-985-6483
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0073961041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool