Organization
DR PATRICIA CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA CLARK PSYD (OWNER)
(503) 294-0940
Entity
Organization
Contact information
Practice address
1132 SW 19TH AVE, PORTLAND, OR 97205-1740
(503) 241-5452
Mailing address
1132 SW 19TH AVE, PORTLAND, OR 97205-1740
(503) 241-5452
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1456
OR
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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