Individual
KORTNEY BOOTH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASE MANAGEMENT
Contact information
Practice address
322 GANNETT DR, EVANSTON, WY 82930-8722
(307) 679-7105
Mailing address
322 GANNETT DR, EVANSTON, WY 82930-8722
(307) 679-7105
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/06/2018
Last updated
12/06/2018
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