Provider Demographics
NPI:1154906360
Name:CLARK, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
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 1:3052 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2229
Mailing Address - Country:US
Mailing Address - Phone:614-517-2002
Mailing Address - Fax:
Practice Address - Street 1:3052 FAIR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2229
Practice Address - Country:US
Practice Address - Phone:614-517-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist