Individual
CYNTHIA ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1011 N MAYFAIR RD, SUITE 304, WAUWATOSA, WI 53226-3431
(414) 453-8380
(414) 443-1635
Mailing address
1011 N MAYFAIR RD, SUITE 304, WAUWATOSA, WI 53226-3431
(414) 453-8380
(414) 443-1635
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1472-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39653700
—
WI
Enumeration date
12/13/2006
Last updated
07/08/2007
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