| Doctor Name: | VICKIE J CLARK |
| NPI Number: | 1376502369 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW PLCSW |
| License Number: | P005563 |
| Business Practice Address: | 2303 Village Dr St Joseph, MO - 645064954 |
| Business Phone Number: | 8162324417 |
| Business Fax Number: | 8169011053 |
| Mailing Address: | Po Box 8612, ST JOSEPH |
| State: | MO |
| Postal Code: | 645088612 |
| Phone Number: | 8162324417 |
| Fax Number: | 8169011053 |
| NPI Enumeration Date: | 03/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | P005563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |