Jon B Clark, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301005160 Issued in MI

Practice address

71 Walnut Blvd
Suite 109
Rochester, MI 48307-2073

Phone

(248) 650-8990

Fax

(248) 650-8990

NPI assigned

Mar 14, 2006

Last updated

Dec 7, 2016By the provider in NPPES

Sex

Male

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1336118454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 WALNUT BLVD",
            "address_2": "SUITE 109",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483072073",
            "telephone_number": "248-650-8990",
            "fax_number": "248-650-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 WALNUT BLVD",
            "address_2": "SUITE 109",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483072073",
            "telephone_number": "248-650-8990",
            "fax_number": "248-650-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JON",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301005160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Jean Ciarelli, RD
• Richard Anthony Cicala, D.C.
• City of Rochester (Rochester Fire Department)
• Amy M Clapp, MPT
• Debra Striler Clark, M.A., PSY.S, L.L.P.
• Matthew Lewis Clark, MD
• Nicole Renee Clark, NP
• Amy Elizabeth Cleland, MPT
• Matthew Sean Akira Clifford, M.D.
• Erica Cogswell

• Psychologist in Rochester, MI
• Providers in Rochester, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.