Provider Demographics
NPI:1063284594
Name:CLARKS CONDENSED, LLC
Entity type:Organization
Organization Name:CLARKS CONDENSED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:720-285-8889
Mailing Address - Street 1:6356 S NEWLAND CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3862
Mailing Address - Country:US
Mailing Address - Phone:720-285-8889
Mailing Address - Fax:
Practice Address - Street 1:6356 S NEWLAND CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3862
Practice Address - Country:US
Practice Address - Phone:720-285-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty