Individual
ANNETTE L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
227 METRO DR, JEFFERSON CITY, MO 65109-1134
(888) 403-1071
(573) 635-7560
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
000329
MO
1041C0700X
Clinical Social Worker
Primary
000329
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
496885914
—
MO
Enumeration date
12/21/2005
Last updated
06/08/2021
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