Individual
JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
1223 CENTER ST STE 22, DES MOINES, IA 50309-1016
(515) 218-6125
(515) 244-5687
Mailing address
6033 PINE RIDGE ST, JOHNSTON, IA 50131-1063
(515) 975-7572
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21040
IA
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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