Jacob Clark

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1416 W Easterday Ave
Sault Sainte Marie, MI 49783-1415

Phone

(906) 632-9809

Fax

(906) 632-9845

NPI assigned

Jan 27, 2025

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)

Not enrolled

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.

• Great Lakes Recovery Centers

  • Children's Substance Abuse Rehabilitation Facility
  • Negaunee, MI
  • NPI 1669899241
  NPD (past)
• Great Lakes Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Negaunee, MI
  • NPI 1760626311
  NPD (past)
• Great Lakes Recovery Centers

  • Substance Abuse Rehabilitation Facility
  • Ironwood, MI
  • NPI 1821267956
  NPD (past)

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1750194643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MALTON RD",
            "city": "NEGAUNEE",
            "state": "MI",
            "postal_code": "498662001",
            "telephone_number": "906-228-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 W EASTERDAY AVE",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831415",
            "telephone_number": "906-632-9809",
            "fax_number": "906-632-9845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2655 Ashmun St",
            "address_purpose": "LOCATION",
            "city": "Sault Sainte Marie",
            "state": "MI",
            "postal_code": "497833711",
            "country_code": "US",
            "telephone_number": "906-632-2522",
            "fax_number": "906-632-2370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 Roosevelt St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Ironwood",
            "state": "MI",
            "postal_code": "499381737",
            "country_code": "US",
            "telephone_number": "906-364-7506",
            "fax_number": "906-364-7508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1115 S Hemlock St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498013800",
            "country_code": "US",
            "telephone_number": "906-774-2561",
            "fax_number": "906-774-2597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 Ludington St",
            "address_purpose": "LOCATION",
            "city": "Escanaba",
            "state": "MI",
            "postal_code": "498293550",
            "country_code": "US",
            "telephone_number": "906-789-3528",
            "fax_number": "906-786-9801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Malton Rd Ste 7&8",
            "address_purpose": "LOCATION",
            "city": "Negaunee",
            "state": "MI",
            "postal_code": "498662001",
            "country_code": "US",
            "telephone_number": "906-485-2347",
            "fax_number": "906-486-1150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Sandpoint Rd",
            "address_purpose": "LOCATION",
            "city": "Munising",
            "state": "MI",
            "postal_code": "498621406",
            "country_code": "US",
            "telephone_number": "906-291-3400",
            "fax_number": "906-464-4043",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Malton Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Negaunee",
            "state": "MI",
            "postal_code": "498662002",
            "country_code": "US",
            "telephone_number": "906-451-4889",
            "fax_number": "906-228-8156",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Malton Rd",
            "address_purpose": "LOCATION",
            "city": "Negaunee",
            "state": "MI",
            "postal_code": "498662000",
            "country_code": "US",
            "telephone_number": "906-228-4692",
            "fax_number": "906-228-2830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "241 Wright St",
            "address_purpose": "LOCATION",
            "city": "Marquette",
            "state": "MI",
            "postal_code": "498551955",
            "country_code": "US",
            "telephone_number": "906-228-7611",
            "fax_number": "906-228-8156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Sault Ste Marie
• Aaron Lee Clark, PT
• Alyssa Clark, MA, CCC-SLP
• Arvid John Narhi Clark, LMSW
• Brian R. Clark, L.P.C.
• Emily Clow
• Hailey Cockerill
• Anesa Antoinette Collier
• Allissa Collins
• Katheryn Conley, M.A. CCC-SLP

• Addiction (Substance Use Disorder) Counselor in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.