FREDERICK CLARK
NPI 1922512607
Case Manager/Care Coordinator in Grand Rapids, MI

Q: What is Frederick Clark's NPI number?

The NPI number for Frederick Clark is 1922512607. It was assigned to this individual provider in the NPPES registry on November 17, 2017.

Q: What is Frederick Clark's specialty?

The primary specialty registered for this NPI is Case Manager/Care Coordinator with taxonomy code 171M00000X.

Q: When was this NPI record last updated?

The NPPES record for Frederick Clark was last updated on March 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.

Active since November 17, 2017

3300 36TH ST SE, GRAND RAPIDS, MI 49512(616) 831-5660 Get Directions Write a Review

NPPES record last updated: March 17, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 17, 2025, Apr 16, 2021, Nov 17, 2017 (3 updates tracked since 2017).

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About Frederick Clark NPPES

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

FREDERICK CLARK (NPI 1922512607) is an individual case manager/care coordinator provider in Grand Rapids, Michigan and active in the NPI registry since November 2017.

NPPES Registry Identity

NPI1922512607

Entity TypeIndividualMale

Primary Taxonomy171M00000X

Provider Legal NameFREDERICK CLARK

Location Address3300 36TH ST SEGrand Rapids, MI 49512-2810

Mailing Address3300 36th St SeGrand Rapids, MI 49512-2810 · (616) 831-5660

Phone(616) 831-5660

Sole ProprietorNo

Enumeration DateNovember 17, 2017

Last NPPES UpdateMarch 17, 20253 updates tracked since enumeration

NPPES CertifiedMarch 13, 2025

✔ NPI 1922512607 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCase Manager/Care CoordinatorOther Service Providers

Taxonomy Code171M00000X

Definition

A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

Also ListedBehavior TechnicianTaxonomy 106S00000X

3300 36TH ST SE, Grand Rapids, MI 49512

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Other Identifiers 1

Medicaid2910854OH

Other Providers at the Same Location NPPES 20

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

DR. KATHERINE E. KUNNEN DNP, FNP-C, PMHNP-BC

Nurse Practitioner (Psychiatric/Mental Health)