MEDICARE: CRYSTAL DAWN CLARK

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1568236016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DAWN CLARK

Provider Business Mailing Address
First Line	:	5400 GREENBRIER RD
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-7623
Country	:	US
Telephone Number	:	304-904-5350
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 GREENBRIER RD
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-7623
Country	:	US
Telephone Number	:	304-904-5350
Fax Number	:

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

Similar Medicare Providers

1750828281 — GRACE WOODS SALEM OPCO, LLC
Practice Location Address:

1166 BENTON RD
SALEM, OH
44460-7623

Practice Phone: 330-332-1104
Practice Fax: 330-337-1273

1255520730 — GRACE WOODS SENIOR LIVING OF SALEM, LLC
Practice Location Address:

1166 BENTON RD
SALEM, OH
44460-7623

Practice Phone: 330-332-1104
Practice Fax: 330-337-1273

1174521850 — DR. MICHELLE RENEE WICKLINE O.D.
Practice Location Address:

RT 1 BOX 75-4
SALEM, WV
26426

Practice Phone: 304-782-1005
Practice Fax: 304-782-3303

1659365724 — TRAVIS PHYSICAL THERAPY & SPORTS MEDICINE INC
Practice Location Address:

RR 1 BOX 75-3
SALEM, WV
26426-9604

Practice Phone: 304-782-1052
Practice Fax: 304-782-1053

1972598191 — MR. JOHN TODD TRAVIS A.T.C., M.S., P.T.
Practice Location Address:

2382 W MAIN ST
SALEM, WV
26426-7521

Practice Phone: 304-782-1052
Practice Fax: 304-782-1053

1477515872 — DR. CAMERON SUSAN FORFAR PH.D.
Practice Location Address:

RR 4 BOX 474
SALEM, WV
26426-8909

Practice Phone: 304-623-3461
Practice Fax:

Directions to “ CRYSTAL DAWN CLARK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.