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General NPI Number Information
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NPI Number | 1508147786
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Entity Type | Individual
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Provider Name | KATRINA ANN CLARK LMP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 411 N MISSION ST
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City | WENATCHEE
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State | WA
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Zip | 98801-2007
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Country | US
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Telephone | 509-679-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 505 W HIGHWAY 2 SUITE 100
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City | LEAVENWORTH
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State | WA
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Zip | 98826-9007
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Country | US
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Telephone | 509-548-8081
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60235994
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License Number State | WA
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