Individual
MS. JESSICA LYNN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA/CAGS
Contact information
Practice address
1190 SW JERICHO AVE, PORT ST LUCIE, FL 34953-6889
(772) 259-0474
Mailing address
1190 SW JERICHO AVE, PORT ST LUCIE, FL 34953-6889
(772) 259-0474
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
SS1724
FL
Other
Enumeration date
12/13/2022
Last updated
12/18/2022
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