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NPI Code Detail

MEDICARE: ANN ELIZABETH CLARK-DELOGU

MEDICARE: ANN ELIZABETH CLARK-DELOGU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175F00000XNaturopath4330OR

General Provider Information

NPI Number : 1700493608
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN ELIZABETH CLARK-DELOGU
Provider Business Mailing Address
First Line : 11720 SE ALDER ST
Second Line :
City : PORTLAND
State : OR
Zip : 97216-3868
Country : US
Telephone Number : 206-902-7168
Fax Number :
Provider Business Practice Location Address
First Line : 608 LANCASTER DR SE
Second Line :
City : SALEM
State : OR
Zip : 97317-5643
Country : US
Telephone Number : 503-877-1995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2020
Last Update Date : 09/25/2020

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Directions to “ ANN ELIZABETH CLARK-DELOGU ” Practice Location

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