Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1477897916 Individual Practitioner Female Practitioner

Kelly Marie Clark , AAC

Peer Specialist • Everett, WA

Professional Overview & Biography Verified Profile Summary

Kelly Clark, AAC is a registered healthcare professional specializing in Peer Specialist in Everett, WA. Practice services are available at 811 MADISON ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

811 Madison St

Everett, WA 982034543

Telephone 4252124200
Fax 4252124201
Associated Practice Facility / Clinic
🏢 Sunrise Services, Inc. Facility NPI 1205917317

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Everett, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
180 Specialists

Practicing in Everett, WA (2660 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License WA 1477897916

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

Definition to come...

Secondary Practice Locations

1100 S 2nd St

Mount Vernon, WA 982734209

Phone: 3604193500

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Rita Kostelik , ARNP

Nurse Practitioner - Psychiatric/Mental Health

NPI 1003009135

Advanced Registered Nurse Practitioner

NPI 1003210477

Registered Nurse

Ashley Dyer

Counselor

NPI 1003261405
Beverly Carman , SUDP

Counselor - Addiction (Substance Use Disorder)

NPI 1003262957
Kayleigh Thomas

Counselor - Mental Health

NPI 1003293663
NPI 1003357856

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
NPI Profile Active November 04, 2017

NPI status registered as active in NPPES database

📍
Updated Business Mailing Address November 04, 2017

Registered at 1100 S 2ND ST, MOUNT VERNON, WA 982734209 (Tel: 3604193500)

📍
Updated Practice Location November 04, 2017

Registered at 811 MADISON ST, EVERETT, WA 982034543 (Tel: 4252124200)

👤
Provider Name / Credentials Updated November 04, 2017

Recorded as KELLY CLARK, AAC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 04, 2017

Counselor

NPI Profile Active August 24, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location August 24, 2016

Registered at 811 MADISON ST, EVERETT, WA 982034543 (Tel: 4252124200)

📍
Updated Business Mailing Address August 24, 2016

Registered at PO BOX 2569, EVERETT, WA 982130569 (Tel: 4252124200)

👤
Provider Name / Credentials Updated August 24, 2016

Recorded as KELLY VARDIMAN, AAC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 24, 2016

Counselor

🟢
Initial NPI Registration & Enumeration November 22, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1477897916
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 22, 2012
Last Update: March 17, 2018
Sole Proprietor: No

Mailing Address

1100 S 2nd St

Mount Vernon, WA 982734209

Phone: 3604193500

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.