Individual
KEISHA ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3711 S VINCENNES AVE, UNIT 614, CHICAGO, IL 60653-1882
(309) 721-8831
Mailing address
3711 S VINCENNES AVE, UNIT 614, CHICAGO, IL 60653-1882
(309) 721-8831
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/05/2013
Last updated
02/05/2013
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