Provider Demographics
NPI:1346397528
Name:CLARK, LAURA STOWELL
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:STOWELL
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 1:309 TROY WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2827
Mailing Address - Country:US
Mailing Address - Phone:801-671-1942
Mailing Address - Fax:801-240-5508
Practice Address - Street 1:132 S STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1506
Practice Address - Country:US
Practice Address - Phone:801-240-6500
Practice Address - Fax:801-240-5508
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327051-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical