Laura Kathleen Clark, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2982-57 Issued in WI

Practice address

122 E Olin Ave
Suite 220
Madison, WI 53713-1487

Phone

(608) 255-9119

Fax

(608) 255-9219

NPI assigned

Dec 14, 2011

Sex

Female

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Psychology Associates LLP

  • Professional Counselor
  • Madison, WI
  • NPI 1902952203
  NPD (past)
• Rusinak Psychology LLC

  • Clinical Psychologist
  • Madison, WI
  • NPI 1518734730
  NPD (past)

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1730458159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E OLIN AVE",
            "address_2": "SUITE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131487",
            "telephone_number": "608-255-9119",
            "fax_number": "608-255-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E OLIN AVE",
            "address_2": "SUITE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131487",
            "telephone_number": "608-255-9119",
            "fax_number": "608-255-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LAURA",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2982-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Clark, PHARMD
• Jenny Esther Clark, MSW, LCSW
• Jimmy Clark Jr., P.A. - C
• Joshua John Clark
• Kenneth W Clark, PH.D.
• Lindsay Clark, PHD
• Maren Alexandra Clark
• Meaghan Ann Clark, MD
• Radonna Clark
• Roseanne Clark, PHD

• Clinical Psychologist in Madison, WI
• Providers in Madison, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.