Clark, Champagne

Clark, Champagne is an individual health care provider with primary practice located at 500B Jefferson Blvd , West Sacramento CA 95605-2349. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Clark, Champagne can be contacted via phone (916) 403-2990.

Contact Information

Primary practice address
500B Jefferson Blvd West Sacramento CA 95605-2349
Phone: (916) 403-2990
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 92250 California

Profile Details

NPI number 1306323563
LBN Legal business name Clark, Champagne
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2018
Last updated Dec 30th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306323563 NPPES
California MEDICAID 000603

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