Individual
PEGGY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
823 KEELER ST, BOONE, IA 50036-2729
(515) 433-2100
(515) 432-5544
Mailing address
1105 1/2 16TH ST, BOONE, IA 50036-1402
(515) 432-6699
(515) 432-5544
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
00235
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED
—
IA
Enumeration date
08/10/2006
Last updated
07/08/2007
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