Clark, Jerry Dean

Clark, Jerry Dean is an individual health care provider with primary practice located at 1616 S Gold St Ste 4 , Centralia WA 98531-8930. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Clark, Jerry Dean can be contacted via phone (360) 807-4929.

Contact Information

Primary practice address
1616 S Gold St Ste 4 Centralia WA 98531-8930
Phone: (360) 807-4929
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X CG60783169 Washington
Other Service Providers / Peer Specialist 175T00000X Washington
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CP61099597 Washington

Profile Details

NPI number 1497232060
LBN Legal business name Clark, Jerry Dean
Credentials SUDR, CPC, AAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2018
Last updated Nov 13th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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