Provider Demographics
NPI:1487525366
Name:CLARK, KARMEN
Entity type:Individual
Prefix:
First Name:KARMEN
Middle Name:
Last Name:CLARK
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:SIENKIEWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1235 SE MORRISON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2462
Mailing Address - Country:US
Mailing Address - Phone:503-746-3373
Mailing Address - Fax:
Practice Address - Street 1:1235 SE MORRISON ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2462
Practice Address - Country:US
Practice Address - Phone:503-746-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health