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Individual

SUSAN L CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9515 60TH AVE W, MUKILTEO, WA 98275
(425) 355-2800
(425) 355-2882
Mailing address
9515 60TH AVE W, MUKILTEO, WA 98275
(425) 355-2800
(425) 355-2882

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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