Kelsey Clark

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2005584 Issued in OH

Practice address

130 Shady Lane Dr
Norwalk, OH 44857-2710

Phone

(567) 743-7199

NPI assigned

Nov 4, 2020

Sex

Female

Sole proprietor

No

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, last updated by the provider on May 3, 2023.

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1174124374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 INDIANA AVENUE",
            "city": "VERMILION",
            "state": "OH",
            "postal_code": "44089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SHADY LANE DR",
            "city": "NORWALK",
            "state": "OH",
            "postal_code": "448572710",
            "telephone_number": "567-743-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2005584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0424118",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Chime, LPC
• Amanda L. Christofferson, NP-C
• Ryan D Christofferson, MD
• Abigail Christine Chudzinski, DO
• Juliana M Clark, COTA/L
• Clear Minds Coaching & Counseling, LLC
• Clear Minds Coaching & Counseling, LLC
• Clear Minds Coaching & Counseling, LLC
• Cli Incorporated
• Cli Incorporated

• All providers in Norwalk, OH
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.