Provider Demographics
NPI:1427611672
Name:CLEMENS, CAITLIN JUNE (LMSW, QIDP)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:JUNE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:LMSW, QIDP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3285 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010
Mailing Address - Country:US
Mailing Address - Phone:269-673-6617
Mailing Address - Fax:
Practice Address - Street 1:3285 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010
Practice Address - Country:US
Practice Address - Phone:269-673-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker