Individual
MARCO CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
PO BOX 87, ALSEA, OR 97324-0087
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A4776
OR
Other
Enumeration date
12/22/2017
Last updated
12/22/2017
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