Individual
AMANDA KATHALEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
522 E HOWARD ST STE 101, HIBBING, MN 55746-1714
(218) 262-0860
(218) 447-7299
Mailing address
522 E HOWARD ST STE 101, HIBBING, MN 55746-1714
(218) 262-0860
(218) 447-7299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301773
MN
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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