| Doctor Name: | SHONTA CLARK |
| NPI Number: | 1326400888 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 325 Rose Ln Saint Louis, MO - 631225911 |
| Business Phone Number: | 3146868444 |
| Business Fax Number: | |
| Mailing Address: | 325 Rose Ln, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631225911 |
| Phone Number: | 3146868444 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2016 |
| NPI Last Update Date: | 03/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |