Provider Demographics
NPI:1427230978
Name:CLARK, SHERRI EVELYN-LEILANI (LADC)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:EVELYN-LEILANI
Last Name:CLARK
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 3RD AVE SE STE 4
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1752
Mailing Address - Country:US
Mailing Address - Phone:218-422-6131
Mailing Address - Fax:
Practice Address - Street 1:720 3RD AVE SE STE 4
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1752
Practice Address - Country:US
Practice Address - Phone:218-422-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302163101YA0400X, 101YA0400X
MN4579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional