Individual
SUSAN L CLARK
Active
Individual
SUSAN L CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
025209MD00022790
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1117944
—
WA
01
—
148493100000
PREMERA
—
01
—
177558
VALUEOPTIONS
WA
01
—
381601
PACIFICARE
—
01
—
389227520070221
COMMUNITY HEALTH PLAN
WA
01
—
822269436
UNITED BEHAVIORAL HEALTH
WA
01
—
91202381600
UNIFORM
—
01
—
9120238161816CL
REGENCE
—
Enumeration date
02/28/2007
Last updated
12/20/2011
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