Individual
MR. JOHN LEWIS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1845 UNIVERSITY AVENUE WEST, ST. PAUL, MN 55104
(651) 644-2600
Mailing address
7352 BOLTON WAY, INVER GROVE HEIGHTS, MN 55076-2337
(651) 450-7327
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7084
MN
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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