Individual
MRS. AMANDA ALYCE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
919 2ND ST NE, CANTON, OH 44704-1132
(330) 933-2339
(330) 454-1476
Mailing address
919 2ND ST NE, CANTON, OH 44704-1132
(330) 933-2339
(330) 454-1476
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0290822
—
OH
Enumeration date
02/19/2015
Last updated
02/25/2015
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