Doctor Name: | STEPHEN JOSEPH CLARK |
NPI Number: | 1073500815 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW |
License Number: | LW00006223 |
Business Practice Address: | 17414 Bothell Way Se Mill Creek, WA - 980126334 |
Business Phone Number: | 4257755955 |
Business Fax Number: | 4254818367 |
Mailing Address: | 17414 Bothell Way Se, MILL CREEK |
State: | WA |
Postal Code: | 980126334 |
Phone Number: | 4257755955 |
Fax Number: | 4254818367 |
NPI Enumeration Date: | 10/05/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LW00006223 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |