Doctor Name: | REBEKAH ANN CLARK |
NPI Number: | 1093953325 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPHA,LCSW |
License Number: | 149013349 |
Business Practice Address: | 4600 3rd St Moline, IL - 612656106 |
Business Phone Number: | 3097792031 |
Business Fax Number: | 3097792027 |
Mailing Address: | 4600 3rd St, MOLINE |
State: | IL |
Postal Code: | 612656106 |
Phone Number: | 3097792031 |
Fax Number: | 3097792027 |
NPI Enumeration Date: | 01/23/2009 |
NPI Last Update Date: | 01/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149013349 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |