Healthcare Provider Details

I. General information

NPI: 1497673768
Provider Name (Legal Business Name): CRYSTAL RAYLENE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 5TH AVE STE 1B
SEQUIM WA
98382-3066
US

IV. Provider business mailing address

230 W MISTY LN
PORT ANGELES WA
98362-8408
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-5100
  • Fax:
Mailing address:
  • Phone: 702-491-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA61391532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: