Individual
DESERIE ALINE CLACK-WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 LAFAYETTE BLVD STE 1128, BRIDGEPORT, CT 06604-4725
(203) 683-3428
(203) 683-5901
Mailing address
1000 LAFAYETTE BLVD STE 1128, BRIDGEPORT, CT 06604-4725
(203) 683-3428
(203) 683-5901
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CT
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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