Individual
MISS STEPHANIE LYNN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
105 CREDES LNDG, ELKVIEW, WV 25071-8185
(304) 965-7979
Mailing address
1 ALEXA WAY APT 4, ELKVIEW, WV 25071-9473
(304) 904-5531
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
50665
WV
Other
Enumeration date
03/11/2015
Last updated
03/11/2015
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