Individual
BENJAMIN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1204 KINGSBURY RD, WASHINGTON, IL 61571-1213
(309) 253-4519
Mailing address
1204 KINGSBURY RD, WASHINGTON, IL 61571-1213
(309) 253-4519
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209029848
IL
Other
Enumeration date
07/02/2024
Last updated
07/15/2024
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