Individual
ALEXANDRIA ELIZABETH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4510 COLLINS BLVD STE 2, ASHTABULA, OH 44004-6954
(866) 534-2639
Mailing address
811 COLUMBUS AVE, ASHTABULA, OH 44004-3547
(440) 813-9670
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S.2403951-TRNE
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074888
—
OH
Enumeration date
09/25/2024
Last updated
01/12/2026
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