Individual
KATHLEEN ANNE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2681
Mailing address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2681
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2262-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39132100
—
WI
Enumeration date
04/06/2007
Last updated
07/08/2007
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