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General NPI Number Information
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NPI Number | 1407250079
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Entity Type | Individual
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Provider Name | CLAIREMARIE CLARK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 425-284-5616
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Fax | 425-523-9164
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Provider Business Mailing Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 425-284-5616
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Fax | 425-523-9164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 60717708
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License Number State | WA
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