Kevin G Clark (NPI# 1265681761, PAC ID# 4789714445) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CLINICAL SOCIAL WORKER.
| Nation Provider ID (NPI) | 1265681761 |
| PAC ID by PECOS | 4789714445 |
| Professional Enrollment ID | I20100608000081 |
| Full Name | Kevin G Clark |
| Organization Legal Name | SNAKE RIVER COUNSELING CENTER LLC |
| Address |
2635 Channing Way Suite B Idaho Falls ID 83404-7518 |
| Phone Number | 2085520490 |
| Gender | M |
| Graduation Year | 2002 |
| Primary Specialty | CLINICAL SOCIAL WORKER |
| Group Practice PAC ID | 3779744263 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2635 Channing Way, Suite B, Idaho Falls, ID 83404-7518 | 2085520490 | SNAKE RIVER COUNSELING CENTER LLC |
| 2635 Channing Way, Idaho Falls, ID 83404-7518 | 2085520490 | SNAKE RIVER COUNSELING CENTER LLC |
| Organization Legal Name | SNAKE RIVER COUNSELING CENTER LLC |
| Physicians | 1 |
| Street Address |
2635 CHANNING WAY SUITE B |
| City | IDAHO FALLS |
| State | ID |
| Zip | 83404-7518 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth Ann Sharp-marsden | Nurse Practitioner | 1680 Elk Creek Dr, Idaho Falls, ID 83404-1225 | |
| Lisa Hong | Occupational Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Brent Kennedy | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Heidi Duran | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Rebecca L Butikofer | Occupational Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Kristan Bullock | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Dawn Taylor | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Brenda Padron | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Kimberly Stowell | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Michael Anderson | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Find all physicians in zip 83404 | |||
| City | IDAHO FALLS |
| Zip Code | 83404 |
| Specialty | CLINICAL SOCIAL WORKER |
| City + Specialty | IDAHO FALLS + CLINICAL SOCIAL WORKER |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.