Individual
SAMANTHA N CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 WALTERSCHEID BLVD APT D203, CHEYENNE, WY 82007-2641
(307) 760-9911
Mailing address
PO BOX 21772, CHEYENNE, WY 82003-7053
(307) 638-1979
(833) 207-0301
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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