Individual
JILL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10373 NE HANCOCK ST, SUITE 200, PORTLAND, OR 97220-3873
(503) 253-8020
Mailing address
8803 SE 12TH AVE, PORTLAND, OR 97202-7097
(503) 754-2477
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4822
OR
Other
Enumeration date
08/13/2007
Last updated
04/08/2011
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