Provider Demographics
NPI:1023714268
Name:CLARK, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 SPRINGFIELD CENTER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1963
Mailing Address - Country:US
Mailing Address - Phone:330-472-3244
Mailing Address - Fax:
Practice Address - Street 1:2186 SPRINGFIELD CENTER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-1963
Practice Address - Country:US
Practice Address - Phone:330-472-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7716378OtherSUMMIT COUNTY DODD
OH77857746Medicaid