Provider Demographics
NPI:1043302490
Name:CLARK, JESSICA A (MSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-2947
Mailing Address - Fax:
Practice Address - Street 1:300 N 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763
Practice Address - Country:US
Practice Address - Phone:402-336-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE828101YA0400X
NE3075101YM0800X
NE12041041C0700X
SD48231041C0700X
NE193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical