Individual
JASON J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPC
Contact information
Practice address
500 S 336TH ST STE 102, FEDERAL WAY, WA 98003-6389
(206) 261-2410
Mailing address
3812 LANYARD DR NE, LACEY, WA 98516-1333
(206) 261-2410
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/19/2022
Last updated
08/19/2022
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