JENDAYA M CLARK (NPI# 1346866563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346866563 |
| Entity Type | Individual |
| Full Name | JENDAYA M CLARK |
| Practice Address |
1201 Cypress Ter Rockford IL 61102-3375 |
| Mailing Address |
Po Box 341 Rockford IL 61105-0341 |
| Practice Telephone | 8155198548 |
| Mailing Telephone | 8155198548 |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 180.012915 | IL | Behavioral Health & Social Service Providers |
| Street Address |
1201 CYPRESS TER |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61102-3375 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115383 | Renee Lynn Keeney | Advanced Practice Midwife | 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 | 2011-08-08 |
| 1689895906 | Linda Lou O'reilly | Local Education Agency (LEA) | 1515 S. Meridian Road, Rockford, IL 61102 | 2007-05-02 |
| 1801012992 | Jennifer Anne Boyd | Developmental Therapist | Nia 1515 S. Meridian Rd., Rockford, IL 61102 | 2007-04-17 |
| 1447751623 | Cynthia Uwase | Dentist | 1200 W State St, Rockford, IL 61102 | 2018-02-23 |
| 1033591847 | Jithinraj Edakkanambeth Varayil | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-29 |
| 1194106849 | Naomi Thompson | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-17 |
| 1811377617 | Serene Antoinette Bethune | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-05 |
| 1013188408 | Gary Patrick Fernando | Pediatrics | 1200 W State St, Rockford, IL 61102 | 2008-03-13 |
| 1265602130 | Martin A Ganan | Pharmacist | 1200 W State St, Pharmacy, Rockford, IL 61102 | 2008-03-07 |
| 1609173434 | Kellie J Gibbons | Registered Nurse | 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 | 2011-02-14 |
| Find all providers in zip 61102 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760045744 | Julianna Jones | Counselor | 6653 Weaver Rd Ste 115, Rockford, IL 61114 | 2019-04-16 |
| 1245706662 | Nannatte Lynne Heshelman | Counselor | 973 N Main St Apt 1, Rockford, IL 61103-7031 | 2018-10-23 |
| 1508342866 | Tiffany Williams | Counselor | 2990 N Perryville Rd Ste 2100b, Rockford, IL 61107-6814 | 2018-07-19 |
| 1487145124 | Rashanda Will | Counselor | 1903 Loomis St, Rockford, IL 61102-2665 | 2018-05-29 |
| 1922467034 | Gregory William Georgis | Counselor | 2595 N Mulford Rd, Rockford, IL 61114-5643 | 2016-02-17 |
| 1194104661 | Lutheran Social Services of Illinois | Counselor | 402 Kishwaukee St, Ste 101, Rockford, IL 61104-2041 | 2015-05-29 |
| 1073936068 | Jordan Bont | Counselor | 8 E Bridge St, Suite E1, Rockford, MI 49341-1601 | 2014-01-27 |
| 1730736141 | Al Despertar Counseling and Guidance Services, LLC | Counselor | 7674 Northland Dr Ne, Rockford, MI 49341-8804 | 2019-08-20 |
| 1033763446 | Linda Haugen | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-07-25 |
| 1366005779 | Jacob Urbelis | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-04-22 |
| Find all providers in ROCKFORD | ||||
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| 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.