Individual
CLARK HAZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Mailing address
PO BOX 3808, PORTLAND, OR 97208-3808
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L14056
OR
Other
Enumeration date
09/08/2020
Last updated
12/17/2024
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