Individual
LOUISE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
345 E 4500 S STE 260, MURRAY, UT 84107-3954
(801) 747-3556
(801) 747-2086
Mailing address
345 E 4500 S STE 260, MURRAY, UT 84107-3954
(801) 747-3556
(801) 747-2086
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497071419
—
UT
Enumeration date
09/01/2010
Last updated
09/01/2010
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