Individual
KIMBERLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 WALKER DR, REXBURG, ID 83440-1657
(208) 359-4764
Mailing address
333 WALKER DR, REXBURG, ID 83440-1657
(208) 359-4764
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-34397
ID
Other
Enumeration date
04/06/2016
Last updated
04/06/2016
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