Provider Demographics
NPI:1114741568
Name:CLARK, CATHY LYNNE
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67440 WARNOCK ST CLAIRSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9125
Mailing Address - Country:US
Mailing Address - Phone:740-338-0637
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 42
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43974-0042
Practice Address - Country:US
Practice Address - Phone:740-546-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty