Healthcare Provider Details

I. General information

NPI: 1134094360
Provider Name (Legal Business Name): KAYLA ROSE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 YOUNGSTOWN POLAND RD
STRUTHERS OH
44471-1103
US

IV. Provider business mailing address

2016 WALKER MILL RD
POLAND OH
44514-3646
US

V. Phone/Fax

Practice location:
  • Phone: 330-318-3078
  • Fax: 234-855-1072
Mailing address:
  • Phone: 724-657-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: