Individual
NICOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APSW, CSAC
Contact information
Practice address
2618 N BREMEN ST, MILWAUKEE, WI 53212-3003
(414) 977-1200
(414) 962-2305
Mailing address
2618 N. BREMEN ST., MILWAUKEE, WI 53121
(414) 977-1200
(414) 962-2305
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
129325-121
WI
104100000X
Social Worker
15777-132
WI
104100000X
Social Worker
SACIT 15578-130
WI
Other
Enumeration date
01/10/2011
Last updated
11/25/2014
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