Sean Clark, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

2003 W Fulton St Ste 300
Chicago, IL 60612-2345

Phone

(312) 850-3438

NPI assigned

Jan 20, 2022

Sex

Male

Sole proprietor

No

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)

Enrolled

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1720730831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 WESLEY AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023462",
            "telephone_number": "618-204-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 W FULTON ST STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122345",
            "telephone_number": "312-850-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SEAN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard N Clark Jr., MD
• Rona Clark
• Sara Elizabeth Clark, MS, OTR/L
• Sarah Clark, LCSW
• Sarah Beth Clark, DNP, FNP-BC
• Shammona Clark, FNP-C
• Sharon Clark
• Shonda T Clark, NP
• Shoshana Leonie Clark
• Stacy Clark, PH.D.

• Registered Dietitian in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.