Individual
MR. BRIAN K CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9200 W LOOMIS RD, #103, FRANKLIN, WI 53132
(414) 425-1250
(414) 425-1459
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1471-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39235600
—
WI
Enumeration date
08/07/2006
Last updated
08/26/2019
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