Rolanda Bailey-Clark

Key facts

NPI

1366089625

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

Practice address

19530 Kedzie Ave
Flossmoor, IL 60422-1778

Phone

(708) 799-2200

Fax

(708) 799-2711

NPI assigned

Dec 5, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 5, 2019.

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1366089625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17746 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604773936",
            "telephone_number": "708-444-1012",
            "fax_number": "708-614-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19530 KEDZIE AVE",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221778",
            "telephone_number": "708-799-2200",
            "fax_number": "708-799-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILEY-CLARK",
        "first_name": "ROLANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-05",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sonya R Baker, LCSW
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• Amy Amanda Bartelment, CF-SLP
• Robin Lee Bartkovsky, B.S., MAT

All providers in Flossmoor, IL · Mental Health Counselor in Illinois