Individual
GRACE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3716 NE MLK JR BLVD, PORTLAND, OR 97212-1111
(503) 288-8066
Mailing address
5302 E MAIN ST APT 253, HILLSBORO, OR 97123-6418
(575) 317-9621
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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