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Contact Information

ANGELIQUE CLARK, ATC
600 PLEASANT AVENUE
PARK RAPIDS, MN56470
 Phone: 218-616-3019
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for ANGELIQUE CLARK · (Female)

NPI # 1659719938
Status Active
Credentials ATC
Entity Individual
Enumeration date 06/10/2013
Last updated 06/10/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 1472
  • MN Medicaid 2255A2300X
  • MN Other 2255A2300X PRIVATE INSURANCE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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