Individual
JESSIE RAMONA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
600 PLEASANT AVE S, PARK RAPIDS, MN 56470
(218) 616-3014
Mailing address
600 PLEASANT AVE S, PARK RAPIDS, MN 56470-1431
(218) 616-3014
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10152
MN
235Z00000X
Speech-Language Pathologist
2202008695
VA
Other
Enumeration date
02/12/2018
Last updated
08/27/2018
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