Individual
REBEKAH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2303 E BURNSIDE ST, PORTLAND, OR 97214-1655
(503) 827-3644
Mailing address
2303 E BURNSIDE ST, PORTLAND, OR 97214-1655
(503) 827-3644
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5914
OR
Other
Enumeration date
12/18/2014
Last updated
12/18/2014
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