Individual
MEGAN RENEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
36 SW NYE ST, NEWPORT, OR 97365-3821
(541) 265-4179
Mailing address
305 NE 36TH ST APT 6, NEWPORT, OR 97365-1676
(541) 852-0915
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
175T00000X
OR
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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