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Individual

MELISSA G CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
1715 SE 32ND PL, PORTLAND, OR 97214-5016
(503) 963-4935
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 963-4935

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A133599
OR
1041C0700X
Clinical Social Worker
A13599
OR

Other

Enumeration date
12/08/2022
Last updated
12/15/2022
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