Provider Demographics
NPI:1659420453
Name:CLARK, ERIKA GAIL
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:GAIL
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:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-0445
Mailing Address - Country:US
Mailing Address - Phone:281-342-7837
Mailing Address - Fax:281-565-8446
Practice Address - Street 1:1804 CARVER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1522
Practice Address - Country:US
Practice Address - Phone:281-342-7837
Practice Address - Fax:281-565-8446
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator