Individual
HALEY R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 LUTHER LN STE 1170, PARK RIDGE, IL 60068-1270
(844) 376-3876
Mailing address
1700 LUTHER LN STE 1170, PARK RIDGE, IL 60068-1270
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-008425
IL
Other
Enumeration date
02/11/2020
Last updated
08/10/2022
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