Individual
MS. CLARE J CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2034 N BURLING ST, CHICAGO, IL 60614-4412
(312) 943-8790
Mailing address
2034 N BURLING ST, CHICAGO, IL 60614-4412
(312) 943-8790
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149002964
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632980
BLUR CROSS PROVIDER #
IL
Enumeration date
11/14/2006
Last updated
07/08/2007
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