Dynetta Clark
Clinical Psychologist
805 Leonard St Ne
Grand Rapids
, Michigan 49503-1138
Dynetta Clark
Clinical Psychologist
805 Leonard St Ne
Grand Rapids
, Michigan 49503-1138
(616) 774-1001
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About
Features
Specialties
- Clinical Psychologist
Languages spoken
- English
Location
First Address
- Dynetta Clark
- 1751 Kendall St Se
- Grand Rapids, MI
- Zip : 49508-3746
- Fax : (616) 774-1001
- Phone : (616) 451-2021
Second Address
- Dynetta Clark
- 805 Leonard St Ne
- Grand Rapids, MI
- Zip : 49503-1138
- Fax : (616) 774-1001
- Phone : (616) 451-2021
Reviews
FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103G00000X | Clinical Psychologist | 6301012368 | MI |
| Y | 103TC0700X | Clinical Psychologist | 6301012368 | MI |
National Provider Identifier
| NPI | 1003125261 |
|---|---|
| Provider Name | Dynetta Clark |
| First Address | Grand Rapids, MI 49508-3746 |
| Second Address | Grand Rapids, MI 49503-1138 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/10/2010 |
| Last Update Date | 05/10/2010 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.