Individual
COLLEEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
21 S MAIN ST UNIT A, ELBURN, IL 60119-9194
(630) 310-2841
Mailing address
1282 SCENIC RD, DEKALB, IL 60115-6109
(630) 310-2841
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.112470
IL
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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