# MRS. KIM CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1508074311
- **Gender:** F
- **Credential:** L.I.C.S.W.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 0890000559 | VT | Yes |
| 1041C0700X | Clinical Social Worker | 101057 | MA | — |

## Other

- **Enumeration date:** 05/18/2007
- **Last updated:** 07/09/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | OVN2222 | — | VT |