Provider Demographics
NPI:1093540262
Name:CLAYBORN, AARON (SACIT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:CLAYBORN
Suffix:
Gender:M
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5803
Mailing Address - Country:US
Mailing Address - Phone:920-254-3278
Mailing Address - Fax:
Practice Address - Street 1:1532 S 10TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5803
Practice Address - Country:US
Practice Address - Phone:920-254-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20658-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)