Individual
JILL R CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
399 E 10TH AVE, EUGENE, OR 97401-3380
(678) 852-8578
Mailing address
399 E 10TH AVE, EUGENE, OR 97401-3380
(678) 852-8578
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
I.1200470
OH
1041C0700X
Clinical Social Worker
Primary
L7010
OR
Other
Enumeration date
05/14/2012
Last updated
03/30/2022
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