Kaeli Ann Clark, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

60295090 Issued in WA

Practice address

2025 112TH Ave NE Ste 101
Bellevue, WA 98004-2943

Phone

(425) 462-8558

Fax

(425) 462-8556

NPI assigned

Jan 31, 2013

Sex

Female

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

State licenses

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

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1427397124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18015 NE 159TH ST",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980726130",
            "telephone_number": "206-419-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 112TH AVE NE STE 101",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042943",
            "telephone_number": "425-462-8558",
            "fax_number": "425-462-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAELI",
        "middle_name": "ANN",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-31",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60295090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarity Healing PLLC
• Hilde Clark-Snustad
• Ann Clark, PH.D.
• Elizabeth Marie Clark, ARNP
• James Eric Clark, M.D.
• Mark Eldon Clark
• Michael Clark, OTR/L
• Nancy L Clark, PA-C
• Robert Leon Clark, MD
• Shauna Clark, RN

• Addiction (Substance Use Disorder) Counselor in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.