Provider Demographics
NPI:1841928611
Name:CLUCHEY, KAMERON NICOLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KAMERON
Middle Name:NICOLE
Last Name:CLUCHEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KAMERON
Other - Middle Name:NICOLE
Other - Last Name:BREUNLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:653 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8866
Mailing Address - Country:US
Mailing Address - Phone:630-292-4331
Mailing Address - Fax:
Practice Address - Street 1:1200 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5728
Practice Address - Country:US
Practice Address - Phone:331-228-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490252471041C0700X
IL20472691041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical