Individual
CANDACE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13136 WESTERN AVE, BLUE ISLAND, IL 60406-2423
(708) 974-5864
Mailing address
10534 S WALDEN PKWY, CHICAGO, IL 60643-2623
(708) 829-0179
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362167940
—
IL
Enumeration date
05/20/2019
Last updated
12/03/2021
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