Individual
BIANCA JASMIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 371-2900
Mailing address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 371-2900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.021215
IL
Other
Enumeration date
05/29/2019
Last updated
05/29/2019
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