Lisa P Clark, RD,LDN, CNSC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164000736 Issued in IL

Practice address

2900 N Lakeshore Drive
Chicago, IL 60657

Phone

(773) 665-3326

Fax

(773) 665-3231

NPI assigned

Jun 15, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1134613953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 N LAKE SHORE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576274",
            "telephone_number": "773-665-3326",
            "fax_number": "773-665-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 N LAKESHORE DRIVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-665-3326",
            "fax_number": "773-665-3231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Ridge Ave",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602023328",
            "country_code": "US",
            "telephone_number": "847-316-2601 x2601",
            "fax_number": "847-316-6214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LISA",
        "middle_name": "P",
        "credential": "RD,LDN, CNSC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164000736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasandria Clark, MD
• Keisha Ann Clark
• Kelly Jo Clark, PT
• Lasheena J. Clark
• Laurel Maxyne Clark, M.D.
• Marcus Clark
• Margaret Harrigan Clark, M.A.
• Marlena Clark, PHD
• Melissa A Clark, LCSW
• Mike A Clark, OT

• Registered Dietitian in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; 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.