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Contact Information

JETTANNA BURRUSS CLARK
22 MEADOW PL
WALDORF, MD20601-2924
 Phone: 240-810-3952
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Case Manager/Care Coordinator

171M00000X
 

Community Health Worker

172V00000X
 

Counselor

101Y00000X
Indicates primary specialty

NPI Profile & details for JETTANNA BURRUSS CLARK · (Female)

NPI # 1902590227
Status Active
Credentials
Entity Individual
Enumeration date 06/08/2023
Last updated 02/11/2026 - About 4 months ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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