Individual
MRS. CARMEN MICHELLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7302 MEADOW RD, CRESTWOOD, KY 40014-9453
(502) 241-5159
Mailing address
7302 MEADOW RD, CRESTWOOD, KY 40014-9453
(502) 241-5159
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
KY
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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