Organization
LISA M. CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA MICHELLE CLARK M.S. (SPEECH-LANGUAGE PATHOLOGIST)
(708) 868-0795
Entity
Organization
Contact information
Practice address
11 ELIZABETH ST, CALUMET CITY, IL 60409-5252
(707) 868-0795
Mailing address
11 ELIZABETH ST, CALUMET CITY, IL 60409-5252
(707) 868-0795
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
22005039A
IN
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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