Doctor Name: | SUSAN MARIE CLARK |
NPI Number: | 1245291079 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M. ED. |
License Number: | RC00039358 |
Business Practice Address: | 12 Satsop Ct Montesano, WA - 985639785 |
Business Phone Number: | 3602494149 |
Business Fax Number: | 3602494149 |
Mailing Address: | Po Box 426, ABERDEEN |
State: | WA |
Postal Code: | 985200099 |
Phone Number: | 3602494149 |
Fax Number: | 3602494149 |
NPI Enumeration Date: | 03/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | RC00039358 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |