Individual
JASON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2451 N LINCOLN AVE SIDE 2, CHICAGO, IL 60614-4170
(773) 469-6675
Mailing address
1166 SILVERWOOD CT APT D1, WHEELING, IL 60090-2431
(847) 951-1961
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/21/2020
Last updated
07/21/2020
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