Individual
JENNIFFER COLLEEN CLARK I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 HAR-BER RD, GROVE, OK 74344
(918) 786-4434
Mailing address
1115 HARBOR RD, GROVE, OK 74344-7918
(918) 786-4434
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/21/2018
Last updated
04/23/2018
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