MEDICARE: CARLY JEAN CLONTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1740128537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY JEAN CLONTS

Provider Business Mailing Address
First Line	:	16454 HICKORY PINE LN APT B
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63011-4755
Country	:	US
Telephone Number	:	573-202-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E NORTH ST
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-1229
Country	:	US
Telephone Number	:	636-733-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ CARLY JEAN CLONTS ” Practice Location

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