Individual
SHANELL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 234-6150
Mailing address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 234-6150
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
372500000X
Chore Provider
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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