Individual
KIMBERLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4350 WOODLAND AVE, JACKSON, MS 39206-3955
(601) 572-3703
Mailing address
4350 WOODLAND AVE, JACKSON, MS 39206-3955
(601) 572-3703
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M5542
MS
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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