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Individual

CASANDRA JEWEL CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8682 INWOOD AVE S, COTTAGE GROVE, MN 55016-4716
(651) 341-9660
Mailing address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(651) 213-4184

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
LP5929
MN
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
09/05/2013
Last updated
09/16/2022
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