Individual
MS. DEIDRE' MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LMFT
Contact information
Practice address
200 4TH AVE W STE 300, SHAKOPEE, MN 55379-1220
(952) 496-8445
Mailing address
26 RIVER WOODS LN, BURNSVILLE, MN 55337-3369
(952) 220-0263
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3698
MN
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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