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General NPI Number Information
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NPI Number | 1033931902
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Entity Type | Individual
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Provider Name | NEAL CLAY IDEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 140 SUNRISE CT. CLINTON, IL 61727
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City | CLINTON
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State | IL
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Zip | 61727-0665
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Country | US
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Telephone | 217-570-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N MAIN ST
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City | DECATUR
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State | IL
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Zip | 62523-1206
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Country | US
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Telephone | 217-362-6262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.030504
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License Number State | IL
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