Individual
JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
620 JOHN AUSTIN LN, MT WASHINGTON, KY 40047-6354
(502) 377-2686
Mailing address
620 JOHN AUSTIN LN, MT WASHINGTON, KY 40047-6354
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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