Organization Active NPI

Clayton & Clayton Counseling, PLLC

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1417720467
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CLAYTON & CLAYTON COUNSELING, PLLC
Practice address
8038 Macintosh LN
Rockford, IL 61107-5336
Phone
(815) 708-7411
NPI assigned
Nov 1, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kayla Anne Clayton, LCSWNPI 1386159747
Title
LCSW/Owner
Phone
(815) 708-7411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

8038 Macintosh LN
Rockford, IL 61107-5336

Mailing address

5062 Rockrose CT Ste 78
Roscoe, IL 61073-7797
Phone (815) 708-7411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240314002485 IL Part B Supplier - Clinic/Group Practice 0749626588 Receives reassigned benefits from 2 practitioners
Practice locations: Rockford, IL

National Provider Directory

National Provider Directory

Locations

5062 Rockrose Ct
Roscoe, IL 61073
Phone (815) 708-7411

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1417720467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5062 ROCKROSE CT STE 78",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610737797",
            "telephone_number": "815-708-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8038 MACINTOSH LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075336",
            "telephone_number": "815-708-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON & CLAYTON COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "LCSW/OWNER",
        "authorized_official_telephone_number": "815-708-7411",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.