Individual
KATHLEEN S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
100 POLK COUNTY PLZ, SUITE 50, BALSAM LAKE, WI 54810-9071
(715) 485-8415
(715) 485-8490
Mailing address
1968 150TH AVE, SAINT CROIX FALLS, WI 54024-8125
(715) 646-2033
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1555 120
WI
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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