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NPI Code Detail

MEDICARE: MS. ASHLEIGH L CLARK BA, CDPT

MEDICARE:  MS. ASHLEIGH L CLARK  BA, CDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCO60783419WA

General Provider Information

NPI Number : 1376055947
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ASHLEIGH L CLARK BA, CDPT
Provider Business Mailing Address
First Line : 5917 CRIMSON CT SE
Second Line :
City : LACEY
State : WA
Zip : 98513-4105
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11702 YELM HWY SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9109
Country : US
Telephone Number : 360-459-9603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2017
Last Update Date : 03/17/2018

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