Provider Demographics
NPI:1033802137
Name:CLARK, CLINTON E
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:E
Last Name:CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25000 EUCLID AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2646
Mailing Address - Country:US
Mailing Address - Phone:216-408-7353
Mailing Address - Fax:
Practice Address - Street 1:1183 CARLYON RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4163
Practice Address - Country:US
Practice Address - Phone:216-408-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker