Katie Jane Clark

NPI #1780225474 in Lebanon, Oregon

Provider Information

NPI Number: 1780225474
Entity Type: Individual
Name: Katie Jane Clark
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Oct 3, 2019
Last Updated: Oct 3, 2019

Practice Location

Address: 44 INDUSTRIAL WAY STE D
City: Lebanon
State: Oregon
ZIP Code: 97355-4364
Phone: (541) 801-4113

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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