Provider Demographics
NPI:1063064780
Name:CLARK, AMY RENAE (HEALTH CARE EDUCATOR)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENAE
Last Name:CLARK
Suffix:
Gender:F
Credentials:HEALTH CARE EDUCATOR
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENAE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMA
Mailing Address - Street 1:2725 SW CEDAR HILLS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1469
Mailing Address - Country:US
Mailing Address - Phone:503-415-4060
Mailing Address - Fax:503-415-4061
Practice Address - Street 1:2725 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1416
Practice Address - Country:US
Practice Address - Phone:503-415-4060
Practice Address - Fax:503-415-4061
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator