Individual
KARLI CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
16131 SE GRAND ST, DAMASCUS, OR 97089-8860
(541) 450-0634
Mailing address
PO BOX 2987, CLACKAMAS, OR 97015-2987
(541) 450-0634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22226
OR
Other
Enumeration date
01/16/2017
Last updated
01/16/2017
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