Mary Anne Clark
Clinical Psychologist
3525 W Peterson Ave Ste 218
Chicago
, Illinois 60659-3314
Mary Anne Clark
Clinical Psychologist
3525 W Peterson Ave Ste 218
Chicago
, Illinois 60659-3314
(773) 430-4601
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About
Features
Specialties
- Clinical Psychologist
Languages spoken
- English
Location
First Address
- Mary Anne Clark
- 3525 W Peterson Ave Ste 218
- Chicago, IL
- Zip : 60659-3314
- Phone : (773) 430-4601
Second Address
- Mary Anne Clark
- 3525 W Peterson Ave Ste 218
- Chicago, IL
- Zip : 60659-3314
- Fax : (773) 478-8145
- Phone : (773) 430-4601
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103G00000X | Clinical Psychologist | 071006752 | IL |
| Y | 103TC0700X | Clinical Psychologist | 071006752 | IL |
National Provider Identifier
| NPI | 1013077361 |
|---|---|
| Provider Name | Mary Anne Clark |
| First Address | Chicago, IL 60659-3314 |
| Second Address | Chicago, IL 60659-3314 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/12/2006 |
| Last Update Date | 07/12/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.