Individual
MRS. JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
59466 COUNTY ROAD 113, ELKHART, IN 46517-3644
(574) 830-5778
Mailing address
59466 COUNTY ROAD 113, ELKHART, IN 46517-3644
(616) 617-6866
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
DO NOT HAVE IDENTIFIERS
MI
Enumeration date
08/12/2022
Last updated
03/19/2024
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