Individual
CRYSTAL JAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPC
Contact information
Practice address
6400 SOUTHCENTER BLVD, TUKWILA, WA 98188-2547
(206) 901-2000
Mailing address
6400 SOUTHCENTER BLVD, TUKWILA, WA 98188-2547
(253) 298-8759
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
WA
Other
Enumeration date
09/24/2018
Last updated
09/22/2025
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