Individual
DR. LAUREL MAXYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 942-5495
(312) 942-5727
Mailing address
6926 N LAKEWOOD AVE, 2ND FLOOR, CHICAGO, IL 60626-3712
(312) 659-3625
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
125.056468
IL
Other
Enumeration date
06/30/2009
Last updated
01/11/2013
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