Healthcare Provider Details

I. General information

NPI: 1205718442
Provider Name (Legal Business Name): JAMI CLARK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15105 S JAMES ST
PLAINFIELD IL
60544-2171
US

IV. Provider business mailing address

17620 S VIRGINIA DR
PLAINFIELD IL
60586-8637
US

V. Phone/Fax

Practice location:
  • Phone: 815-592-2893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.024314
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: