Individual
STACY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
25 E WASHINGTON ST, 1719, CHICAGO, IL 60602-1708
(773) 263-0003
Mailing address
25 E WASHINGTON ST, 1791, CHICAGO, IL 60602-1708
(773) 263-0003
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007953
IL
Other
Enumeration date
08/05/2010
Last updated
10/28/2014
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