Active NPI
Concetta M Clark, M.A.
- Audiologist
- Glen Ellyn, IL
National Provider Identifier
1770809659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 147.000791
- Practice address
- 426 Roosevelt Rd
Glen Ellyn, IL 60137-5611 - Phone
- (630) 469-6061
- NPI assigned
- Apr 16, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 147.000791 | IL | Primary |
Addresses
Primary practice location
426 Roosevelt Rd
Glen Ellyn, IL 60137-5611
Mailing address
426 Roosevelt Rd
Glen Ellyn, IL 60137-5611
Phone (630) 469-6061
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147.000791 | IL | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MLM USA LLC | Audiologist | Past | Accepting new patients |
Organizations & group practices 1
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": "1271376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271376000000",
"number": "1770809659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "426 ROOSEVELT RD",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601375611",
"telephone_number": "630-469-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 ROOSEVELT RD",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601375611",
"telephone_number": "630-469-6061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CONCETTA",
"middle_name": "M",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-16",
"last_updated": "2010-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IL",
"license": "147.000791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.