Individual
KATIE JANE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 INDUSTRIAL WAY STE D, LEBANON, OR 97355-4364
(541) 801-4113
Mailing address
1305 HILL ST SE, ALBANY, OR 97322-6711
(541) 801-4113
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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