Individual
BETH ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
195 N 1950 W, SALT LAKE CITY, UT 84116-3100
(435) 590-0503
Mailing address
195 N 1950 W, SALT LAKE CITY, UT 84116-3100
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
UT
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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