Individual
AMY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, SAC
Contact information
Practice address
9200 W LOOMIS RD STE 217, FRANKLIN, WI 53132
(414) 773-4312
Mailing address
9200 W LOOMIS RD STE 217, FRANKLIN, WI 53132-8887
(414) 773-4312
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16182-132
WI
1041C0700X
Clinical Social Worker
Primary
8789-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100077875
—
WI
Enumeration date
04/11/2018
Last updated
06/05/2024
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