MRS. MANDI LYNNE CLARK (NPI# 1093239758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093239758 |
| Entity Type | Individual |
| Full Name | MRS. MANDI LYNNE CLARK |
| Credential | NCSP |
| Practice Address |
310 S Coal St Colchester IL 62326-1209 |
| Mailing Address |
737 Madelyn Ave Macomb IL 61455-3030 |
| Practice Telephone | 3097763002 |
| Practice Fax Number | 3097763002 |
| Mailing Telephone | 3097763002 |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
1909260 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 310 S Coal St, Colchester, IL 623261209 | 3097763002 | 3097763002 |
| Street Address |
310 S COAL ST |
| City | COLCHESTER |
| State | IL |
| Zip Code | 62326-1209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023535762 | Jennifer D Percy | Speech-Language Pathologist | 310 S Coal St, Colchester, IL 62326-1209 | 2017-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386846848 | West Prairie Cusd 103 | Local Education Agency (LEA) | 204 S Hun St, Colchester, IL 62326-1129 | 2007-06-05 |
| 1023281847 | Paula R Icenogle | Driver | 708 Sherry St, Colchester, IL 62326-1176 | 2008-04-13 |
| 1699228882 | Memorial Hospital Association | Clinic/Center | 110 E Market St, Colchester, IL 62326-1271 | 2016-07-25 |
| 1043624265 | Haleigh Haddix | Speech-Language Pathologist | 13370 E 700th St, Colchester, IL 62326-1547 | 2014-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174130157 | Justin Michael Boufford | Pharmacist | 218 Lower Mountian View Dr., Colchester, VT 05446 | 2020-09-24 |
| 1780290882 | Jacob Chwiedz | Physical Therapist | 179 Linwood Ave Unit A-4, Colchester, CT 06415-1160 | 2020-09-23 |
| 1851906135 | Brendan Copley | Specialist/Technologist | 352 Belair Dr, Colchester, VT 05446-6544 | 2020-09-13 |
| 1548874555 | Bryan Wilkinson | Social Worker | 123 Meadow Dr, Colchester, VT 05446-6422 | 2020-09-08 |
| 1922617885 | Cody W Brown | Chiropractor | 261 Mountain View Dr Ste 401, Colchester, VT 05446-8047 | 2020-07-27 |
| 1215553730 | Maura Powers | Nurse Practitioner | 33 Farm Gate Rd, Colchester, CT 06415-2622 | 2020-06-20 |
| 1588289664 | Jillian Thompson | Speech-Language Pathologist | 156 Chimney Hill Dr, Colchester, VT 05446-7364 | 2020-06-14 |
| 1558984583 | The Promptcare Companies, Inc. | Durable Medical Equipment & Medical Supplies | 948 Hercules Dr, Colchester, VT 05446-5976 | 2020-05-26 |
| 1336760339 | Amela Graco | Counselor | 108 Kathleen Ln, Colchester, VT 05446-7999 | 2020-04-30 |
| 1174154991 | The Vermont Center for Responder Wellness | Social Worker | 162 Hegeman Avenue, Suite 100, Colchester, VT 05446 | 2020-01-30 |
| Find all providers in COLCHESTER | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679428 | Jessica Scharf | Psychologist | 8502 Bailey Rd # 63, Darien, IL 60561-5333 | 2020-11-06 |
| 1225637283 | Nicole Maggard | Psychologist | 137 Somerset Rd, Willowbrook, IL 60527-5470 | 2020-10-21 |
| 1033724232 | Shadequia Davis | Psychologist | 402 Richards St, Joliet, IL 60433-2218 | 2020-09-14 |
| 1043823123 | Lindsay Ann Franklin | Psychologist | 436 Coral Dr, Morton, IL 61550-8505 | 2020-08-28 |
| 1053923995 | Annie Biehl | Psychologist | 9750 Soreng Ave, Schiller Park, IL 60176-2105 | 2020-08-21 |
| 1811508989 | Caroline Cook | Psychologist | 246 S Fair Ave, Elmhurst, IL 60126-3600 | 2020-08-12 |
| 1760009955 | Tammy Carroll | Psychologist | 3801 Lake Ct, Trenton, IL 62293-2938 | 2020-07-03 |
| 1316568629 | Denisa Kerekes | Psychologist | 1536 Cedarwood Ct, Gurnee, IL 60031-6346 | 2020-04-28 |
| 1740801174 | Jessica Berlinghof | Psychologist | 220 Greenwood Dr, Round Lake Park, IL 60073-3444 | 2020-04-27 |
| 1861038200 | Ease of Mind Pllc | Psychologist | 10526 West Cermak Road, Suite 308aa, Westchester, IL 60154 | 2019-11-20 |
| Find all providers with the same taxonomy | ||||
| City | COLCHESTER |
| Zip Code | 62326 |
Please comment or provide details below to improve the information on MRS. MANDI LYNNE CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.