Kimberly R Clark, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S1100497 Issued in OH

Practice address

5465 Main St
Sylvania, OH 43560-2155

Phone

(419) 885-8800

Fax

(419) 885-8600

NPI assigned

Jun 8, 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

Opted out of Medicare

Yes, effective Apr 16, 2024 through Apr 16, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Agape and Eros Healing Collaborative, LLC

  • Clinical Social Worker
  • Toledo, OH
  • NPI 1851254429
  NPD Authorized official
• Bedford Behavioral Health

  • Professional Counselor
  • Lambertville, MI
  • NPI 1528337706
  NPD (past)

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1861786790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5465 MAIN ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602155",
            "telephone_number": "419-885-8800",
            "fax_number": "419-885-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5465 MAIN ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602155",
            "telephone_number": "419-885-8800",
            "fax_number": "419-885-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-08",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1100497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April L Checovich
• Rick A Cherry, O.D.
• Christine a. Raszka, LMT, LLC
• Holly Cipriani
• Lisa Clair, MED
• Thomas John Clement, PTA
• Rachel Parker Colby, MD
• Melissa Colcord, MSOT, OTR/L
• Cadey Joyceann Cole, AT, ATC
• Gwendolyn Coley

• All providers in Sylvania, OH
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.