S L Clark MD Inc PS

Primary specialty

Psychoanalysis PsychologistTaxonomy code 103TP0814X

License

MD00022790 Issued in WA

Legal business name

S L CLARK MD INC PS

Doing business as

Susan L. Clark, M.D.

Practice address

9515 60TH Ave W
Mukilteo, WA 98275

Phone

(425) 355-2800

Fax

(425) 355-2882

NPI assigned

Oct 16, 2007

Organization subpart

No

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

Authorized official

Name

Susan L Clark, MD

Title

President

Phone

(425) 355-2800

Specialties & licenses 2

Addresses

Other names 1

• Susan L. Clark, M.D. Doing business as

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1528257433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9515 60TH AVE W",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "98275",
            "telephone_number": "425-355-2800",
            "fax_number": "425-355-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9515 60TH AVE W",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "98275",
            "telephone_number": "425-355-2800",
            "fax_number": "425-355-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S L CLARK MD INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-355-2800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "WA",
            "license": "MD00022790",
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": "WA",
            "license": "MD00022790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan L. Clark, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald a Krueger MD Inc PS
• Marc Root
• Jennifer Rose, RN
• Marline Rostom, MA, LMHC
• Judy A Rybak, LMP
• Sheila Setsuko Sagami, OTR
• Peter Salama, D.C.
• Ghada Salem
• Michael Sams
• Dayna Leigh Sanders, MA, CCC-SLP

• Psychoanalysis Psychologist in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Psychoanalysis Psychologist in Washington

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