Individual
JEFFREY PAUL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
1932 VIKING DR NW, ROCHESTER, MN 55901-2460
(180) 042-2016
Mailing address
1926 26TH AVE NW, ROCHESTER, MN 55901-8064
(507) 261-2777
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3310
MN
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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