Clark, Anne W
Clark, Anne W is an individual health care provider with primary practice located at 9000 N Lombard St , Portland OR 97203-3006. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Anne W can be contacted via phone (503) 988-5304.Contact Information
Primary practice address
9000 N Lombard St
Portland OR 97203-3006
Phone: (503) 988-5304
Fax: (503) 988-5305
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 1941 | Oregon |
Profile Details
| NPI number | 1245569326 |
|---|---|
| LBN Legal business name | Clark, Anne W |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 18th, 2009 |
| Last updated | Apr 6th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245569326 | NPPES |
| Oregon | MEDICAID | 096511 | |
| Oregon | MEDICAID | 022959 |
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