| NPI | 1417596685 |
|---|---|
| Former Name | HEATHER RENEE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149019577) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 995540) |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2020-01-05 |