Casandra Jewel Clark

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

8682 Inwood Ave S
Cottage Grove, MN 55016-4716

Phone

(651) 341-9660

NPI assigned

Sep 5, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1902231210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15251 PLEASANT VALLEY RD",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550129640",
            "telephone_number": "651-213-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8682 INWOOD AVE S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164716",
            "telephone_number": "651-341-9660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2265 Como Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551081737",
            "country_code": "US",
            "telephone_number": "866-821-0281",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15251 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Center City",
            "state": "MN",
            "postal_code": "550129640",
            "country_code": "US",
            "telephone_number": "651-213-4184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CASANDRA",
        "middle_name": "JEWEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-05",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5929",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Ann Chamberlain
• Shaswita Chintalpuri, MD
• Victoria Chiou, M.D.
• Frances E Churchill
• City of Cottage Grove
• Comfortcare Services Co
• Consilon
• Ann R Cook, BA, LADC
• Cottage Grove Chiropractic Clinic, PA
• Cottage Grove Smiles Dentistry, PC

• Student in an Organized Health Care Education/Training Program in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Student in an Organized Health Care Education/Training Program in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.