Provider Demographics
NPI:1417833799
Name:CLAYBERG, SHANELLE ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:ELAINE
Last Name:CLAYBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANELLE
Other - Middle Name:ELAINE
Other - Last Name:LETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W148N10455 BLACKBIRD PT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-1407
Mailing Address - Country:US
Mailing Address - Phone:217-299-7339
Mailing Address - Fax:
Practice Address - Street 1:W148N10455 BLACKBIRD PT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-1407
Practice Address - Country:US
Practice Address - Phone:217-299-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490217141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical