Healthcare Provider Details

I. General information

NPI: 1295538452
Provider Name (Legal Business Name): RYAN CLARK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 7TH ST SW
CANTON OH
44710-1801
US

IV. Provider business mailing address

2581 PARMALEE DR
SEVEN HILLS OH
44131-4114
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6223
  • Fax: 330-363-3877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: