Provider Demographics
NPI:1992285878
Name:CLAYTON, HANNAH ELIZABETH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15415 NW STATE ROUTE AA
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MO
Mailing Address - Zip Code:64720-4890
Mailing Address - Country:US
Mailing Address - Phone:816-730-9917
Mailing Address - Fax:
Practice Address - Street 1:15415 NW STATE ROUTE AA
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720-4890
Practice Address - Country:US
Practice Address - Phone:816-730-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician