Individual
CARA ARIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(971) 600-5847
Mailing address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(971) 600-5847
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
TWH000110358
OR
175T00000X
Peer Specialist
THW000107924
OR
Other
Enumeration date
01/12/2024
Last updated
01/12/2024
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