Sandra Louise Clark, NCACII, LADC, CCJP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

301712 Issued in MN

Practice address

1885 University Ave W
Suite 20
Saint Paul, MN 55104-3489

Phone

(651) 373-0152

Fax

(763) 767-3145

NPI assigned

Feb 26, 2008

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

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": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203984000000",
    "number": "1306015284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 UNIVERSITY AVE W",
            "address_2": "SUITE 20",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043489",
            "telephone_number": "651-373-0152",
            "fax_number": "763-767-3145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 UNIVERSITY AVE W",
            "address_2": "SUITE 20",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043489",
            "telephone_number": "651-373-0152",
            "fax_number": "763-767-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SANDRA",
        "middle_name": "LOUISE",
        "credential": "NCACII, LADC, CCJP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kali Jo Clark, RN
• Kirby Dwight Clark, M.D.
• Mary A Clark
• Molly Regina Marie Clark, MD
• Renee Lynn Clark, DNP, CNM
• Mary Colleen Clarke, MA
• Sadie Barrett Clarke
• Susan Legender Clarke, DC
• Lauren Clarkson
• Wanda Classen

• Addiction (Substance Use Disorder) Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; 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.