Provider Demographics
NPI:1396070496
Name:CLARK, CATHY (CD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 ROUTE 322
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-3560
Mailing Address - Country:US
Mailing Address - Phone:814-849-6844
Mailing Address - Fax:814-849-6844
Practice Address - Street 1:3432 ROUTE 322
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-3560
Practice Address - Country:US
Practice Address - Phone:814-849-6844
Practice Address - Fax:814-849-6844
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula