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NPI Code Detail

MEDICARE: DR. PAMELA M. CLARK PSY.D.

MEDICARE: DR. PAMELA M. CLARK PSY.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
1103T00000XPsychologistPY60517271WA

General Provider Information

NPI Number : 1730264334
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA M. CLARK PSY.D.
Provider Business Mailing Address
First Line : 3124 S REGAL ST
Second Line :
City : SPOKANE
State : WA
Zip : 99223-4704
Country : US
Telephone Number : 509-464-6208
Fax Number :
Provider Business Practice Location Address
First Line : 3124 S REGAL ST
Second Line :
City : SPOKANE
State : WA
Zip : 99223-4704
Country : US
Telephone Number : 509-464-6208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 01/09/2020

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