Nicole Clem

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2405750 Issued in OH

Practice address

15 E Pleasant St
Springfield, OH 45506-2201

Phone

(937) 325-5564

Fax

(937) 325-8727

NPI assigned

Jan 23, 2020

Last updated

Aug 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Nicole Butler Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Health Services for Clark Co Inc

  dba Mental Health Services for Clark and Madison Counties, Inc.

  • Multi-Specialty Clinic/Center
  • Springfield, OH
  • NPI 1982695706
  Medicare reassignment NPD
• Mental Health Services for Clark Co Inc

  dba Mental Health Services for Clark and Madison Cos, Inc

  • Multi-Specialty Clinic/Center
  • Springfield, OH
  • NPI 1598022758
  NPD
• Wellspring

  • Mental Health Counselor
  • Springfield, OH
  • NPI 1003851411

  Clinical

  NPD (past)
• Wellspring

  • Addiction (Substance Use Disorder) Counselor
  • Springfield, OH
  • NPI 1912262619
  NPD (past)

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1336779818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 E PLEASANT ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455062201",
            "telephone_number": "937-325-5564",
            "fax_number": "937-325-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 E PLEASANT ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455062201",
            "telephone_number": "937-325-5564",
            "fax_number": "937-325-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEM",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2001258-TRNE",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2433503",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BUTLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kandice Clark
• Latasha Nichole Clark
• Teresa Clark, PSYCHOLOGIST LICENSE
• Timothy Clark, RPA-C
• Daniel George Clauer, D.D.S.
• Katelyn Marie Clevenger
• Carrie Clevland
• Gene A. Clifton, D.D.S.
• Heather Cline
• Kylie Nicole Cline, RN

• Clinical Social Worker in Springfield, OH
• Providers in Springfield, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.