Richard Jack Clark, PEER SUPPORT

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

#518 Issued in UT

Practice address

68 S 600 E
Salt Lake City, UT 84102-1007

Phone

(801) 428-3244

NPI assigned

May 10, 2016

Last updated

May 11, 2016By the provider in NPPES

Sex

Male

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": "1462838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462924800000",
    "number": "1316393283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 S 600 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021007",
            "telephone_number": "801-428-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 S 600 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021007",
            "telephone_number": "801-428-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RICHARD",
        "middle_name": "JACK",
        "credential": "PEER SUPPORT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "UT",
            "license": "#518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norman James Clark, MD
• Paul Clark
• Rachael Clark, MD
• Rachel Clark
• Randy Clark
• Sam Burk Clark
• Sara Clark
• Sara Jean Clark
• Scott A Clark, DPM
• Spencer Clark

• Peer Specialist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Peer Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.