Individual
KAELI ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
2025 112TH AVE NE STE 101, BELLEVUE, WA 98004-2943
(425) 462-8558
(425) 462-8556
Mailing address
18015 NE 159TH ST, WOODINVILLE, WA 98072-6130
(206) 419-9168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60295090
WA
Other
Enumeration date
01/31/2013
Last updated
01/31/2013
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