Provider Information for 1841529161
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Mrs. HEATHER WINONA CLARK M.A., L.P.C.
Sex: Female
NPI: 1841529161
Last Updated: 2009-12-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1841529161 | ||||||||
| Enumeration Date | 2009-12-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 14377 WOODLAKE DR SUITE 308 CHESTERFIELD, MO 63017-5735 United States Phone: 314-576-6493 | Fax:314-576-7319 | ||||||||
| Primary Practice Address | 14377 WOODLAKE DR SUITE 308 CHESTERFIELD, MO 63017-5735 United States Phone: 314-576-6493 | Fax:314-576-7319 | ||||||||
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