JACOB CLARK
Complete NPI Record 1750194643
Counselor - Addiction (Substance Use Disorder) in Sault Sainte Marie, MI
Active since January 27, 2025
Complete NPI Dataset
This page contains the complete raw NPPES record for Jacob Clark (NPI 1750194643), an individual counselor provider in Sault Sainte Marie, MI. All 24 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1750194643 Field 1/24
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/24
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: CLARK Field 3/24
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: JACOB Field 4/24
- The first name of the provider, if the provider is an individual.
- Provider First Line Business Mailing Address: 100 MALTON RD Field 5/24
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: NEGAUNEE Field 6/24
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MI Field 7/24
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 498662001 Field 8/24
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/24
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9062289699 Field 10/24
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 1416 W EASTERDAY AVE Field 11/24
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SAULT SAINTE MARIE Field 12/24
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MI Field 13/24
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 497831415 Field 14/24
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 15/24
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9066329809 Field 16/24
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9066329845 Field 17/24
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 20/24
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 101YA0400X Field 21/24
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 22/24
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 23/24
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 9
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2655 Ashmun St
Location 1/9Sault Sainte Marie, MI 49783-3711 · Phone (906) 632-2522 · Fax (906) 632-2370
220 Roosevelt St Ste 2
Location 2/9Ironwood, MI 49938-1737 · Phone (906) 364-7506 · Fax (906) 364-7508
1115 S Hemlock St Ste 1
Location 3/9Iron Mountain, MI 49801-3800 · Phone (906) 774-2561 · Fax (906) 774-2597
1101 Ludington St
Location 4/9Escanaba, MI 49829-3550 · Phone (906) 789-3528 · Fax (906) 786-9801
1500 Sandpoint Rd
Location 5/9Munising, MI 49862-1406 · Phone (906) 291-3400 · Fax (906) 464-4043
100 Malton Rd Ste 1
Location 6/9Negaunee, MI 49866-2002 · Phone (906) 451-4889 · Fax (906) 228-8156
104 Malton Rd
Location 7/9Negaunee, MI 49866-2000 · Phone (906) 228-4692 · Fax (906) 228-2830
241 Wright St
Location 8/9Marquette, MI 49855-1955 · Phone (906) 228-7611 · Fax (906) 228-8156
100 Malton Rd Ste 7&8
Location 9/9Negaunee, MI 49866-2001 · Phone (906) 485-2347 · Fax (906) 486-1150
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