Active NPI
Taylor Clark, LCSW
- Clinical Social Worker
- Baker City, OR
National Provider Identifier
1740729599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L4730
- Practice address
- 2100 Main St
Baker City, OR 97814-2655 - Phone
- (541) 523-7400
- Fax
- (541) 523-4927
- NPI assigned
- Feb 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L4730 | OR | Primary |
Addresses
Primary practice location
2100 Main St
Baker City, OR 97814-2655
Mailing address
2100 Main St
Baker City, OR 97814-2655
Phone (541) 523-7400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L4730 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1740729599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 MAIN ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978142655",
"telephone_number": "541-523-7400",
"fax_number": "541-523-4927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 MAIN ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978142655",
"telephone_number": "541-523-7400",
"fax_number": "541-523-4927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TAYLOR",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-13",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L4730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baker City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.