Provider Demographics
NPI:1821770660
Name:CLARK, BRANDY RENE MICHELE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENE MICHELE
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 1:1127 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3607
Mailing Address - Country:US
Mailing Address - Phone:509-663-6901
Mailing Address - Fax:
Practice Address - Street 1:1127 MONROE ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3607
Practice Address - Country:US
Practice Address - Phone:509-663-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker