LENNEE CLARK (NPI# 1578085924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578085924 |
| Entity Type | Individual |
| Full Name | LENNEE CLARK |
| Credential | PSS |
| Practice Address |
75 S 5th St Cottage Grove OR 97424-2008 |
| Mailing Address |
Po Box 5 Cottage Grove OR 97424-0001 |
| Practice Telephone | 5417674260 |
| Practice Fax Number | 5416491697 |
| Mailing Telephone | 5419423939 |
| Mailing Fax Number | 5419429310 |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2017-09-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
THW2138 | OR | Behavioral Health & Social Service Providers |
| Y | 175T00000X | Peer Specialist | OR | Other Service Providers |
| Street Address |
75 S 5TH ST |
| City | COTTAGE GROVE |
| State | OR |
| Zip Code | 97424-2008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679079396 | Caleb O'day Beauchene | Peer Specialist | 75 S 5th St, Cottage Grove, OR 97424-2008 | 2018-04-02 |
| 1689196008 | Paul Joseph Miller | Peer Specialist | 75 S 5th St, Cottage Grove, OR 97424-2008 | 2017-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851936157 | Naomi Higgs | Physical Therapy Assistant | 515 Grant St, Cottage Grove, OR 97424 | 2019-11-10 |
| 1588131296 | Home Town Drugs of Cottage Grove, Inc. | Pharmacy | 1205 Hwy 99 North, Cottage Grove, OR 97424 | 2018-10-31 |
| 1215420625 | Zachary Booth | Student in an Organized Health Care Education/Training Program | 28188 Cottage Grove Lorane Rd, Cottage Grove, OR 97424 | 2018-06-11 |
| 1124404090 | Eileen Nittler | Social Worker | 1345 Birch Avenue, Cottage Grove, OR 97424 | 2015-08-03 |
| 1851799787 | Kathryn Brooks | Licensed Practical Nurse | 520 Patrick Loop, Cottage Grove, OR 97424 | 2014-12-09 |
| 1558767814 | Michele Renee Savage | Orthotic Fitter | 148 Gateway Blvd, Cottage Grove, OR 97424 | 2014-11-14 |
| 1730598558 | John Mansfield | Pharmacist | 120 Andrew Drive, Cottage Grove, OR 97424 | 2014-08-06 |
| 1700213493 | Aspen Injury Center LLC | Chiropractor | 1260 East Main Street, Cottage Grove, OR 97424 | 2013-09-26 |
| 1609172956 | Megan Olds | Counselor | 37 South 6th Street, Cottage Grove, OR 97424 | 2011-02-03 |
| 1144530726 | Monica G Radley | Counselor | 1345 Birch Ave., Cottage Grove, OR 97424 | 2010-10-15 |
| Find all providers in zip 97424 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003449935 | Ryan Matthew Trapp | Peer Specialist | 1245 Birch Ave, Cottage Grove, OR 97424-1413 | 2020-02-19 |
| 1679079396 | Caleb O'day Beauchene | Peer Specialist | 75 S 5th St, Cottage Grove, OR 97424-2008 | 2018-04-02 |
| 1881117331 | David Karl Chavez | Peer Specialist | 1450 Birch Ave, Cottage Grove, OR 97424-1417 | 2017-07-17 |
| 1689196008 | Paul Joseph Miller | Peer Specialist | 75 S 5th St, Cottage Grove, OR 97424-2008 | 2017-07-07 |
| 1598200909 | Christopher L Dayton | Peer Specialist | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2016-12-21 |
| 1659727428 | Joseph James Bucher | Peer Specialist | 1450 Birch Ave, Cottage Grove, OR 97424-1417 | 2016-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
| Find all providers with the same taxonomy | ||||
| City | COTTAGE GROVE |
| Zip Code | 97424 |
Please comment or provide details below to improve the information on LENNEE 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.