Anne W Clark, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1941 Issued in OR

Practice address

9000 N Lombard St
Portland, OR 97203-3006

Phone

(503) 988-5304

Fax

(503) 988-5305

NPI assigned

Dec 18, 2009

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Central City Concern

  • Substance Abuse Rehabilitation Facility
  • Portland, OR
  • NPI 1679832315
  NPD (past)
• Central City Concern, Inc

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1548071848
  NPD (past)

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

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1245569326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 SW OAK ST",
            "address_2": "STE.210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972041817",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 N LOMBARD ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033006",
            "telephone_number": "503-988-5304",
            "fax_number": "503-988-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANNE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-18",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ella Clark-Nicholson, PA-C
• Aleasha Nicol Clark
• Alexander Victor Clark
• Amanda Clark
• Amanda Lou Clark, MD
• Benjamin Clark, CPO
• Brian D Clark, MD, PHD
• Brinton Carey Clark
• Caitlin Clark, MA
• Cara Dawn Clark, N.D.

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.