Provider Demographics
NPI:1801510813
Name:CLARK, MELISSA (ND)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W ELLIOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1206
Mailing Address - Country:US
Mailing Address - Phone:480-557-9095
Mailing Address - Fax:480-557-9643
Practice Address - Street 1:850 W ELLIOT RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1206
Practice Address - Country:US
Practice Address - Phone:480-557-9095
Practice Address - Fax:480-557-9643
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1743175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath