| Kaeli A. Clark | |
|
17924 140th Ave Ne Ste#230 Woodinville WA 98072-4315 | |
| (206) 419-9168 | |
| (206) 555-5555 |
| Full Name | Kaeli A. Clark |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 17924 140th Ave Ne, Woodinville, Washington |
| Authorized Official Name and Position | Kaeli A Clark (OWNER) |
| Authorized Official Contact | 2064199168 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaeli A. Clark 17924 140th Ave Ne Ste #230 Woodinville WA 98072 Ph: (206) 419-9168 | Kaeli A. Clark 17924 140th Ave Ne Ste#230 Woodinville WA 98072-4315 Ph: (206) 419-9168 |
| NPI Number | 1811304025 |
|---|---|
| Provider Enumeration Date | 07/21/2014 |
| Last Update Date | 07/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811304025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 60295090 (Washington) | Primary |
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