Individual
GREGORY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 N BEAUMONT RD, PRAIRIE DU CHIEN, WI 53821-1445
(563) 252-2537
(608) 326-0420
Mailing address
225 N BEAUMONT RD, PRAIRIE DU CHIEN, WI 53821-1445
(563) 252-2537
(608) 326-0420
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2888-125
WI
Other
Enumeration date
12/26/2005
Last updated
07/08/2007
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