Individual
JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
152 FIRST AVE N, ILWACO, WA 98624
(503) 960-5098
Mailing address
5 N HIGHWAY 101 # 188, WARRENTON, OR 97146-9313
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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