| Doctor Name: | MS. JESSICA A CLARK |
| NPI Number: | 1043302490 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 828 |
| Business Practice Address: | 1421 N 10th St Oneill, NE - 687631170 |
| Business Phone Number: | 4023363747 |
| Business Fax Number: | 4023363096 |
| Mailing Address: | Po Box 918, 1421 N 10th Street ONEILL |
| State: | NE |
| Postal Code: | 687630918 |
| Phone Number: | 4023363747 |
| Fax Number: | 4023363096 |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 07/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 828 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |