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SHELLEY LYNN CLARK LICSW
NPI 1063235992
Social Worker - Clinical in Vancouver, WA

Active since November 07, 2024PECOS EnrolledAccepts Medicare Assignment
2513 NW 117TH ST, VANCOUVER, WA 98685(360) 991-6272 Get Directions Write a Review

NPPES record last updated: December 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 10, 2024, Nov 7, 2024 (2 updates tracked since 2024).

About Shelley Lynn Clark Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLEY LYNN CLARK LICSW (NPI 1063235992) is an individual clinical provider in Vancouver, Washington, licensed in Washington (LW61516470) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS, is affiliated with Ascension Sacred Heart Bay, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1063235992
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameSHELLEY LYNN CLARKCredential: LICSW
Location Address2513 NW 117TH STVancouver, WA 98685-3667
Mailing Address2513 Nw 117th StVancouver, WA 98685-3667 · (360) 991-6272
Phone(360) 991-6272
Sole ProprietorYes
Medical School CMSOtherGraduated 2009
Enumeration DateNovember 7, 2024
Last NPPES UpdateDecember 10, 20242 updates tracked since enumeration
NPPES CertifiedDecember 10, 2024
✔ NPI 1063235992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in WA · LW61516470
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
2513 NW 117TH ST, Vancouver, WA 98685
Open in Google Maps ↗

Secondary Practice Locations 2

Location 11615 Delaware StLongview, WA 98632-2367 · Phone (360) 414-2091
Location 21718 E Kessler BlvdLongview, WA 98632-1842 · Phone (360) 747-5800 · Fax (360) 575-3846

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shelley Lynn Clark Licsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2769919737
PECOS Enrollment IDI20250102003422
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shelley Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Peacehealth
32 mi
Multi-Specialty
1615 DELAWARE ST
Longview, WA 98632
  • Reassigned Medicare billing, Washington enrollment
  • 308 clinicians in this Medicare group
NPI 1720056187 (360) 414-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ascension Sacred Heart Bay

Acute Care Hospitals · Panama City, FL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100026
Location615 N Bonita AvePanama City, FL 32401 · Bay County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98685 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $57.27 – $172.80
Typical copayment $0.00 (range $14.31 – $43.20)
Most-billed visit code NA
Established Patient
$71.29 typical visit price
range $18.56 – $141.11
Typical copayment $17.82 (range $4.64 – $35.27)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelley Clark's NPI number?

The NPI number for Shelley Clark is 1063235992. It was assigned to this individual provider in the NPPES registry on November 7, 2024.

Where is Shelley Clark located?

Shelley Clark practices at 2513 NW 117th St, Vancouver, WA 98685. The listed phone number is (360) 991-6272.

What is Shelley Clark's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Shelley Clark enrolled in Medicare?

Yes. Shelley Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Shelley Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shelley Clark reassigns Medicare benefits to Peacehealth (Longview, WA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shelley Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shelley Clark accept?

Health plans from Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Shelley Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Shelley Clark affiliated with any hospitals?

According to CMS data, Shelley Clark is affiliated with Ascension Sacred Heart Bay.

When was this NPI record last updated?

The NPPES record for Shelley Clark was last updated on December 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.