Individual
VICKIE DIANE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10905 NE 10TH ST, MIDWEST CITY, OK 73130-2209
(918) 791-1995
Mailing address
10905 NW 10TH ST., MIDWEST CITY, OK 74344
(918) 791-1995
(405) 769-7572
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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