Individual
CLARK KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
799 LEXINGTON AVE, MANSFIELD, OH 44907-1906
(419) 756-5133
(419) 774-9707
Mailing address
5910 BLUESTONE WAY, LEWIS CENTER, OH 43035-7550
(614) 301-2639
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
32698321
OH
Other
Enumeration date
05/16/2022
Last updated
01/09/2023
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