MEDICARE: DR. JANET LEE CLARK PH.D.

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
1	103T00000X	Psychologist	3908	OH

General Provider Information

NPI Number	:	1427019926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET LEE CLARK PH.D.

Provider Business Mailing Address
First Line	:	5801 THOMPSON RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1349
Country	:	US
Telephone Number	:	614-855-1170
Fax Number	:	614-855-1170

Provider Business Practice Location Address
First Line	:	3449 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2220
Country	:	US
Telephone Number	:	614-231-7255
Fax Number	:	614-855-1170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	09/26/2007

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