Individual
DR. BRUCE E CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 993-3123
(952) 993-3286
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP7036
MN
103TC0700X
Clinical Psychologist
LP7036
MN
Other
Enumeration date
05/30/2024
Last updated
08/09/2024
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