Individual
SHANNA MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1213 W HANKS TRL, WOODWARD, OK 73801-7601
(405) 519-2668
Mailing address
PO BOX 1213, LAVERNE, OK 73848-1213
(405) 519-2668
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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