Individual
HEIDI C. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31912 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9700
(360) 633-1902
Mailing address
PO BOX 65, SUQUAMISH, WA 98392-0065
(360) 265-0270
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CP00005554
WA
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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