Jaclyn Clarke
Individual provider Active NPI Counselor · Burns Harbor, IN
NPI 1962010314 · NPPES record last updated Jul 21, 2020
Key facts
- NPI
- 1962010314
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1245 Coan St
Burns Harbor, IN 46304-9764 - Phone
- (773) 322-7075
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abbie Kelley, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1245 Coan St
Burns Harbor, IN 46304-9764
Mailing address
1245 Coan St
Burns Harbor, IN 46304-9764
Phone (773) 322-7075
Other providers in Burns Harbor, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.