Provider Demographics
NPI:1023736162
Name:CLAYBORN, SETH JEROME
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:JEROME
Last Name:CLAYBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JEAN
Other - Last Name:MORRELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:751 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-2215
Mailing Address - Country:US
Mailing Address - Phone:502-471-6554
Mailing Address - Fax:
Practice Address - Street 1:181 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1387
Practice Address - Country:US
Practice Address - Phone:812-496-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004155A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN46004155AOtherINDIANA PROFESSIONAL LICENSING AGENCY