Individual
MRS. KIM CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.I.C.S.W.
Contact information
Practice address
226 LEONARD RD, SOUTH ROYALTON, VT 05068-9565
(802) 763-8773
Mailing address
226 LEONARD RD, SOUTH ROYALTON, VT 05068-9565
(802) 763-8773
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000559
VT
1041C0700X
Clinical Social Worker
101057
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN2222
—
VT
Enumeration date
05/18/2007
Last updated
07/09/2007
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