Individual
ELLA ROSE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3640 COLONEL GLENN HWY, BEAVERCREEK, OH 45324-2029
(937) 775-3490
Mailing address
92 CERAMIC DR, COLUMBUS, OH 43214-3004
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
OH
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OH
Other
Enumeration date
09/24/2025
Last updated
01/14/2026
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