Most Relevant Information
Provider Data
| NPI Number: | 1003482654 |
| Provider Name: | KATRINA ANN CLARK CSWA |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | A5091 |
Most Important Dates
| Enumeration Date: | 06/02/2021 |
| Last Updated: | 06/02/2021 |
Provider Practice Location
1715 E BURNSIDE ST STE 201
PORTLAND
OR
972141531
Practice Location Phone/Fax
| Phone: | 8083432163 |
| Fax: |
Provider Mailing Location
2177 SE UMATILLA ST
PORTLAND
OR
972027414
Provider Mailing Phone/Fax
| Phone: | 8083432163 |
| Fax: |