Individual provider Active NPI

Dawn Clark

  • Professional Counselor
  • Rochester, MN
National Provider Identifier
1528730652
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
401 16TH St SE
Rochester, MN 55904-7973
Phone
(507) 516-0030
Fax
(507) 516-0031
NPI assigned
Sep 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 304749 MN
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

401 16TH St SE
Rochester, MN 55904-7973

Mailing address

902 2ND Ave NW
Byron, MN 55920-1332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20240416001634 MN Practitioner - Mental Health Counselor 6305285925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

401 16TH St SE
Suite 100
Rochester, MN 55904-7974
Phone (507) 516-0030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
304749MNMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Mar 4, 2024 Accepting new patients
Family Support Services Inc. PastSince Mar 3, 2024 Accepting new patients

Locations

6600 France Ave S
Ste 425
Edina, MN 55435
Phone (952) 243-8300

17685 Juniper Path
Ste 303
Lakeville, MN 55044
Phone (952) 214-8959

1101 E 78th St
Ste 100
Minneapolis, MN 55420
Phone (952) 234-8604

401 16th St SE
Ste 100
Rochester, MN 55904
Phone (507) 516-0030

3535 40th Ave NW
Ste 210
Rochester, MN 55901
Phone (507) 516-0227

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1811 Weir Dr
Ste 270
Woodbury, MN 55125
Phone (651) 243-6087

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1528730652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 2ND AVE NW",
            "city": "BYRON",
            "state": "MN",
            "postal_code": "559201332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 16TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559047973",
            "telephone_number": "507-516-0030",
            "fax_number": "507-516-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAWN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-28",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304749",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.