Individual
LISA P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LDN, CNSC
Contact information
Practice address
2900 N LAKESHORE DRIVE, CHICAGO, IL 60657
(773) 665-3326
(773) 665-3231
Mailing address
2900 N LAKE SHORE DR, CHICAGO, IL 60657-6274
(773) 665-3326
(773) 665-3231
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164000736
IL
Other
Enumeration date
06/15/2018
Last updated
06/15/2018
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