MEDICARE: ANDREA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1508649070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CLARK

Provider Business Mailing Address
First Line	:	1530 VANCE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-2246
Country	:	US
Telephone Number	:	260-200-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 VANCE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-2246
Country	:	US
Telephone Number	:	260-200-3988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	09/03/2025

Similar Medicare Providers

1700660412 — ANDREA CLARK LCSW LLC
Practice Location Address:

1530 VANCE AVE
FORT WAYNE, IN
46805-2246

Practice Phone: 260-200-3988
Practice Fax:

1417880147 — THE MILK MIND LLC
Practice Location Address:

9308 BECKETT LN APT 4205
FORT WORTH, TX
76123-2246

Practice Phone: 718-207-5110
Practice Fax:

1013959394 — LAKEWOOD PARK WALK-IN CLINIC, LLC
Practice Location Address:

5059 TURNPIKE FEEDER RD
FORT PIERCE, FL
34951-2246

Practice Phone: 772-465-8588
Practice Fax:

1104040740 — DR. BOB X. JING DDS
Practice Location Address:

2246 JACKSBORO HWY , STE 112
FORT WORTH, TX
76114-2330

Practice Phone: 214-738-1528
Practice Fax: 214-987-9446

1437304771 — BOB JING DDS PA
Practice Location Address:

2246 JACKSBORO HWY , SUITE 112
FORT WORTH, TX
76114-2330

Practice Phone: 817-529-1799
Practice Fax: 817-529-1795

1861706012 — DR. WILLIAM FIORE DMD
Practice Location Address:

2246 JACKSBORO HWY STE 122
FORT WORTH, TX
76114-2363

Practice Phone: 817-529-1799
Practice Fax:

Directions to “ ANDREA CLARK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.