Katrina Ann Clark, CSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

A5091 Issued in OR

Practice address

1715 E Burnside St Ste 201
Portland, OR 97214-1531

Phone

(808) 343-2163

NPI assigned

Jun 2, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beyond Healing LLC

  • Adult Mental Health Clinic/Center
  • Kailua Kona, HI
  • NPI 1740039833
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1003482654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2177 SE UMATILLA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027414",
            "telephone_number": "808-343-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 E BURNSIDE ST STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141531",
            "telephone_number": "808-343-2163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2177 SE Umatilla St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972027414",
            "country_code": "US",
            "telephone_number": "808-343-2163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATRINA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "CSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "A5091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1715 E Burnside St Ste 201",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972141531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Dyann Clark
• Joshua Clark, PHD
• Justin Clark, LMT
• Kalin Burkhardt Clark, PSY.D
• Karmen Clark
• Kendall Olivia Clark
• Kim M Clark, O.D.
• Kylie Clark, M.D.
• Leonard Clark, CERTIFIED ALCOHOL &
• Liberty Sky Clark

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.