Clark, Russell

Clark, Russell is an individual health care provider with primary practice located at 3649 Meramec St , Saint Louis MO 63116-4411. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Community Health Worker, Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is his primary health care specialty. Clark, Russell can be contacted via phone (314) 930-9384.

Contact Information

Primary practice address
3649 Meramec St Saint Louis MO 63116-4411
Phone: (314) 930-9384
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Community Health Worker 172V00000X
Other Service Providers / Peer Specialist 175T00000X

Profile Details

NPI number 1659111508
LBN Legal business name Clark, Russell
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 29th, 2024
Last updated May 29th, 2024 - about last year

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.

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