Individual
MS. DAVETTE M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4856 CASTLE DARGAN DR., COUNTRY CLUB HILLS, IL 60478-5820
(708) 957-8616
(708) 957-8617
Mailing address
4856 CASTLE DARGAN DRIVE, COUNTRY CLUB HILLS, IL 60478-5820
(708) 957-8616
(708) 957-8617
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/26/2007
Last updated
07/08/2007
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