Search › Idaho › 101YM0800X
Camillia Clark, COUI-9541
NPI 1528840584 · on the registry since 2023
Practice
- Address
- 452 D St
Idaho Falls, ID 83402 - Phone
- (208) 552-0355
- Fax
- (208) 200-3201
- Organisation at this address
- Vista Family Services Llc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 17
Registry record
- Primary taxonomy
- 101YM0800X
101YM0800X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2023-10-16
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 Idaho