Individual
BERTHA DENISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFLE
Contact information
Practice address
1212 GULFSTREAM WAY, MASCOUTAH, IL 62258-2869
(907) 240-3141
Mailing address
1212 GULFSTREAM WAY, MASCOUTAH, IL 62258-2869
(907) 240-3141
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/24/2025
Last updated
01/24/2025
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