Individual
AASIYAH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2222 N MAYFAIR RD, WAUWATOSA, WI 53226-2262
(414) 939-9390
Mailing address
2222 N MAYFAIR RD STE 120, WAUWATOSA, WI 53226-2262
(414) 939-9390
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
3700-226
WI
101YP2500X
Professional Counselor
Primary
7572-125
WI
Other
Enumeration date
06/18/2013
Last updated
12/13/2019
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