Individual
LAURA ANNE PETTIS-CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA-R
Contact information
Practice address
12901 SE 97TH AVE STE 340, CLACKAMAS, OR 97015-7903
(503) 655-8045
(523) 655-6806
Mailing address
2300 NE 165TH DR, PORTLAND, OR 97230-5525
(971) 285-2476
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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