Provider Demographics
NPI:1962924571
Name:KELLOUGH-CLAYTON, SARAH FRIEND (MSW LISW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FRIEND
Last Name:KELLOUGH-CLAYTON
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:FRIEND
Other - Last Name:KELLOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:150 POSTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16007241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical