Provider Demographics
NPI:1174879571
Name:CLARK, CLAIRE ALEXIS (MS)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ALEXIS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ALEXIS
Other - Last Name:HEROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 S PENN SQ STE 960
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3400
Mailing Address - Country:US
Mailing Address - Phone:215-873-2030
Mailing Address - Fax:855-282-1285
Practice Address - Street 1:1 S PENN SQ STE 960
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-873-2030
Practice Address - Fax:855-282-1285
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS