| Doctor Name: | MRS. SHANNON JACKIE CLARK |
| NPI Number: | 1700940855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 11816 |
| Business Practice Address: | 10750 S Knoll Crest Ln Tucson, AZ - 857069052 |
| Business Phone Number: | 5205742911 |
| Business Fax Number: | 5207500056 |
| Mailing Address: | 10750 S Knoll Crest Ln, TUCSON |
| State: | AZ |
| Postal Code: | 857069052 |
| Phone Number: | 5205742911 |
| Fax Number: | 5207500056 |
| NPI Enumeration Date: | 12/21/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171W00000X |
| License Number: | 11816 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |