Provider Demographics
NPI:1255052718
Name:CLARK, ABIGAIL HOPE (MA)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:HOPE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2904
Mailing Address - Country:US
Mailing Address - Phone:920-246-1119
Mailing Address - Fax:
Practice Address - Street 1:1428 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2904
Practice Address - Country:US
Practice Address - Phone:920-246-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach