Individual
MRS. TANYA MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
J.D.
Contact information
Practice address
17601 ADDISON ST, SOUTHFIELD, MI 48075-2764
(248) 227-2029
Mailing address
PO BOX 182, SOUTHFIELD, MI 48037-0182
(248) 227-2029
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
09/27/2009
Last updated
09/27/2009
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