Individual
MR. GREGORY D CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
118 BROADWAY N, STE 810, FARGO, ND 58102-4949
(701) 799-8785
(701) 205-4930
Mailing address
118 BROADWAY N, STE 810, FARGO, ND 58102-4949
(701) 799-8785
(701) 205-4930
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LICSW 2973
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015066
BCBS OF ND PIN
ND
01
—
03Q32CL
BCBS OF MN PIN
MN
Enumeration date
07/10/2006
Last updated
03/25/2016
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