Individual
JACLYN CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1245 COAN ST, BURNS HARBOR, IN 46304-9764
(773) 322-7075
Mailing address
1245 COAN ST, BURNS HARBOR, IN 46304-9764
(773) 322-7075
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/21/2020
Last updated
07/21/2020
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