Individual
LENNEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
75 S 5TH ST, COTTAGE GROVE, OR 97424-2008
(541) 767-4260
(541) 649-1697
Mailing address
PO BOX 5, COTTAGE GROVE, OR 97424-0001
(541) 942-3939
(541) 942-9310
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
THW2138
OR
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
07/07/2017
Last updated
09/27/2017
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