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1053625764
STACY CLARK
CHICAGO, IL
NPI
1053625764
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: IL 071.007953)
Enumeration Date
2010-08-05
Last Update Date
2014-10-28
Business Address
-- STACY CLARK Ph.D.
25 E WASHINGTON ST 1719
CHICAGO, IL 60602-1708
Phone number: 773-263-0003
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Mailing Address
-- STACY CLARK Ph.D.
25 E WASHINGTON ST 1791
CHICAGO, IL 60602-1708
Phone number: 773-263-0003
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