Individual
JULIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 E LINCOLN RD STE B, IDABEL, OK 74745-7342
(972) 439-6569
Mailing address
PO BOX 52, LANE, OK 74555-0052
(972) 439-6569
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
CF675
OK
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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