MS. DAVETTE M CLARK (NPI# 1750417614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750417614 |
| Entity Type | Individual |
| Full Name | MS. DAVETTE M CLARK |
| Other Name | MRS. DAVETTE M CLARK-JOHNSON |
| Practice Address |
4856 Castle Dargan Dr. Country Club Hills IL 60478-5820 |
| Mailing Address |
4856 Castle Dargan Drive Country Club Hills IL 60478-5820 |
| Practice Telephone | 7089578616 |
| Practice Fax Number | 7089578617 |
| Mailing Telephone | 7089578616 |
| Mailing Fax Number | 7089578617 |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4856 CASTLE DARGAN DR. |
| City | COUNTRY CLUB HILLS |
| State | IL |
| Zip Code | 60478-5820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285266296 | Infinity Love Care LLC | Hospice Care, Community Based | 1153 Williamsburg Road, Country Club Hills, IL 60478 | 2020-02-07 |
| 1467911313 | Atlas & Associates, Inc | Durable Medical Equipment & Medical Supplies | 4907 Sunset Lane, Country Club Hills, IL 60478 | 2019-03-19 |
| 1780196022 | Katrina Crosby | Non-emergency Medical Transport (VAN) | 18261 Ravisloe Terrace, Country Club Hills, IL 60478 | 2017-10-26 |
| 1063949675 | Rashunda Lee | Nurse Practitioner | 17469 Park Lane, Country Club Hills, IL 60478 | 2017-05-12 |
| 1558809947 | Jaylin Omauri Banks | Specialist/Technologist | 17791 Princeton Lane, Country Club Hills, IL 60478 | 2017-02-06 |
| 1083072276 | Lynn Banks | Occupational Therapy Assistant | 17800 Rosewood Terrace, Country Club Hills, IL 60478 | 2016-02-03 |
| 1215323019 | Norm Brown | Case Management | 19432 Elm Dr, Country Club Hills, IL 60478 | 2015-04-09 |
| 1265841746 | Glorinda Conley Henry | Health Educator | 4131 W. 192nd Pl., Country Club Hills, IL 60478 | 2014-08-08 |
| 1447663398 | Lillian Moore | Nurse Practitioner | 4724 West 175th Place, Country Club Hills, IL 60478 | 2014-06-09 |
| 1578999348 | Ihuoma C Ozoh | Pharmacist | 18331 Mulberry Terrace, Country Club Hills, IL 60478 | 2013-09-24 |
| Find all providers in zip 60478 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255815791 | Shannon Ellison | Developmental Therapist | 3818 169th St, Country Club Hills, IL 60478-2138 | 2018-09-20 |
| 1750818415 | Elona Johnson | Developmental Therapist | 18024 Birch Ave, Country Club Hills, IL 60478-5110 | 2017-05-12 |
| 1194188987 | Elizabeth Edohen | Developmental Therapist | 17856 Park View Dr, Country Club Hills, IL 60478-2906 | 2016-03-30 |
| 1568696821 | Latrica Tenille Day | Developmental Therapist | 17790 Springfield Ave, Country Club Hills, IL 60478-4849 | 2009-05-14 |
| 1376718965 | Maryann J. Scarborough | Developmental Therapist | 16835 Glen Oaks Dr, Country Club Hills, IL 60478-2147 | 2008-04-24 |
| 1740498930 | Stacey Richardson | Developmental Therapist | 17736 Sycamore Ave, Country Club Hills, IL 60478-4870 | 2007-05-19 |
| 1619195062 | Debra G. Siddall | Developmental Therapist | 4129 177th St, Country Club Hills, IL 60478-4859 | 2007-04-23 |
| 1104040849 | Geralyn L Johnson | Developmental Therapist | 4133 192nd Ct, Country Club Hills, IL 60478-5807 | 2007-04-12 |
| 1144359886 | Valerie L Wilson | Developmental Therapist | 18085 Vista Dr, Country Club Hills, IL 60478-2905 | 2007-03-05 |
| 1396868162 | Lynnette Degraffenreid | Developmental Therapist | 4880 Castle Dargan Dr, Country Club Hills, IL 60478-5820 | 2007-04-09 |
| Find all providers in COUNTRY CLUB HILLS | ||||
| City | COUNTRY CLUB HILLS |
| Zip Code | 60478 |
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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.