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Individual

SHARON V CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LAT

Contact information

Practice address
621 SCIENCE DR, MADISON, WI 53711-1074
(608) 263-4765
Mailing address
5910 DRIFTWOOD AVE, MADISON, WI 53705-4418
(608) 231-6764

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
153-039
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
153-039
ATHLETIC TRAINER
WI
Enumeration date
07/21/2006
Last updated
07/08/2007
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