Individual
MRS. GRACIELA MARIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
430 W 5TH S APT 507, REXBURG, ID 83440-2347
(208) 757-1330
Mailing address
430 W 5TH S APT 507, REXBURG, ID 83440-2347
(208) 757-1330
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/24/2009
Last updated
08/24/2009
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