Provider Demographics
NPI:1528299302
Name:CLYMER, SHELLEY RAE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:RAE
Last Name:CLYMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 3RD AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8000
Mailing Address - Country:US
Mailing Address - Phone:309-786-4491
Mailing Address - Fax:309-786-0205
Practice Address - Street 1:1800 3RD AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8000
Practice Address - Country:US
Practice Address - Phone:309-786-4491
Practice Address - Fax:309-786-0205
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist