NPIMap

Organization Active NPI

Lisa M. Clark

  • Early Intervention Provider Agency
  • Calumet City, IL
National Provider Identifier
1346533635
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
22005039A Issued in IN
Legal business name
LISA M. CLARK
Practice address
11 Elizabeth St
Calumet City, IL 60409-5252
Phone
(707) 868-0795
NPI assigned
May 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Authorized official

Name
Mrs. Lisa Michelle Clark, M.S.
Title
Speech-Language Pathologist
Phone
(708) 868-0795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 22005039A IN Primary

Addresses

Primary practice location

11 Elizabeth St
Calumet City, IL 60409-5252

Mailing address

11 Elizabeth St
Calumet City, IL 60409-5252
Phone (707) 868-0795

National Provider Directory

National Provider Directory
Tax ID family
Aw Holdings LLC53 organizations share this tax ID, including this one

NPI Registry JSON

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1346533635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ELIZABETH ST",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095252",
            "telephone_number": "707-868-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ELIZABETH ST",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095252",
            "telephone_number": "707-868-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA M. CLARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "708-868-0795",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IN",
            "license": "22005039A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; 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.