Individual
DR. RICHARD JOSEPH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
6700 N PORT WASHINGTON RD, GLENDALE, WI 53217-3919
(414) 351-0450
(414) 351-8845
Mailing address
2312 N GRANDVIEW BLVD, SUITE 104, WAUKESHA, WI 53188-1600
(262) 522-8512
(262) 244-0914
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1893057
WI
Other
Enumeration date
11/20/2006
Last updated
04/25/2012
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