JERRY DEAN CLARK SUDR, CPC, AAC
NPI 1497232060
Counselor - Addiction (Substance Use Disorder) in Centralia, WA

Q: What is Jerry Clark's NPI number?

The NPI number for Jerry Clark is 1497232060. It was assigned to this individual provider in the NPPES registry on July 25, 2018.

Q: What is Jerry Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Clark was last updated on November 13, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 25, 2018

1616 S GOLD ST STE 4, CENTRALIA, WA 98531(360) 807-4929 Get Directions Write a Review

NPPES record last updated: November 13, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 13, 2020, Oct 30, 2020, Mar 25, 2020 and 2 more (5 updates tracked since 2018).

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About Jerry Dean Clark Sudr, Cpc, Aac NPPES

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

JERRY DEAN CLARK SUDR, CPC, AAC (NPI 1497232060) is an individual addiction (substance use disorder) provider in Centralia, Washington, licensed in Washington (CP61099597) and active in the NPI registry since July 2018.

NPPES Registry Identity

NPI1497232060

Entity TypeIndividualMale

Primary Taxonomy101YA0400X

Provider Legal NameJERRY DEAN CLARKCredential: SUDR, CPC, AAC

Location Address1616 S GOLD ST STE 4Centralia, WA 98531-8930

Mailing AddressPo Box 2394Longview, WA 98632 · (360) 200-5419 · Fax (360) 200-6736

Phone(360) 807-4929

Sole ProprietorNo

Enumeration DateJuly 25, 2018

Last NPPES UpdateNovember 13, 20205 updates tracked since enumeration

NPPES CertifiedNovember 13, 2020

✔ NPI 1497232060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

License✔ Licensed in WA · CP61099597

Also ListedPeer SpecialistTaxonomy 175T00000X · License CG60783169 (WA)

1616 S GOLD ST STE 4, Centralia, WA 98531

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Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICKY ANNE GEE CPC, AAC

Counselor (Mental Health)