Individual
SUE CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
507 E ARMSTRONG AVE, REGIONAL DEVELOPMENT CENTER, PEORIA, IL 61603-3201
(309) 681-6960
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
01
—
IL01Z4
JOHN DEERE
IL
Enumeration date
02/14/2006
Last updated
07/09/2007
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