Leonard Clark, CERTIFIED ALCOHOL &

NPI 1518226216 · on the registry since 2012 · sole proprietor

Practice

Address: 4134 N. Vancouver Ave., Suite 303c
Portland, OR 97217
Phone: (503) 593-7764
Organisation at this address: Reaching In Serving Kids
Shellmire Unlimited, P.C.
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 4

Registry record

Primary taxonomy: 101YA0400X
101YA0400X
Licence states on file: OR
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2012-05-15

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon