Healthcare Provider Details

I. General information

NPI: 1578750501
Provider Name (Legal Business Name): XIOMARA D. CLANTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

2347 GROVE AVE
BERWYN IL
60402-2523
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax: 708-656-6430
Mailing address:
  • Phone: 708-795-1082
  • Fax: 708-749-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149008721
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: