Individual
ANDREA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1 CHILDRENS PL, FOOD AND NUTRITION LS-15, SAINT LOUIS, MO 63110-1002
(314) 454-2648
(314) 454-2557
Mailing address
1 CHILDRENS PL, FOOD AND NUTRITION LS-15, SAINT LOUIS, MO 63110-1002
(314) 454-2648
(314) 454-2557
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
133VN1004X
MO
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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