Individual
JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15600 36TH AVE N STE 120, PLYMOUTH, MN 55446-3687
(763) 595-0812
Mailing address
145 ARABIAN AVE W, SHAKOPEE, MN 55379-4642
(925) 864-1720
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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