Active NPI
Winnifred D Clark
- School Counselor
- Wickenburg, AZ
National Provider Identifier
1164556965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- Practice address
- 920 S. Vulture Mine Road
Special Service
Wickenburg, AZ 85390 - Phone
- (928) 684-6714
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | AZ | Primary |
Addresses
Primary practice location
920 S. Vulture Mine Road
Special Service
Wickenburg, AZ 85390
Mailing address
12013 N 115TH Ave
El Mirage, AZ 85335-6001
Phone (928) 684-6714
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109869 | Other | AZ | AHCCCS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1164556965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12013 N 115TH AVE",
"city": "EL MIRAGE",
"state": "AZ",
"postal_code": "853356001",
"telephone_number": "928-684-6714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 S. VULTURE MINE ROAD",
"address_2": "SPECIAL SERVICE",
"city": "WICKENBURG",
"state": "AZ",
"postal_code": "85390",
"telephone_number": "928-684-6714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WINNIFRED",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS PROVIDER NUMBER",
"identifier": "109869",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wickenburg, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.