| M. A. Clark, Inc | |
|
7358 N Lincoln Ave Ste 170 Lincolnwood IL 60712-1710 | |
| (773) 430-4601 | |
| Not Available |
| Full Name | M. A. Clark, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 7358 N Lincoln Ave Ste 170, Lincolnwood, Illinois |
| Authorized Official Name and Position | Mary Anne Clark (PRESIDENT) |
| Authorized Official Contact | 7734304601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M. A. Clark, Inc 7358 N Lincoln Ave Ste 170 Lincolnwood IL 60712-1710 Ph: (773) 430-4601 | M. A. Clark, Inc 7358 N Lincoln Ave Ste 170 Lincolnwood IL 60712-1710 Ph: (773) 430-4601 |
| NPI Number | 1467634972 |
|---|---|
| Provider Enumeration Date | 11/27/2007 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 6901831262 |
|---|---|
| Medicare Enrollment ID | O20051005000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467634972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071006752 (Illinois) | Primary |
| Provider Name | Mary Anne Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013077361 PECOS PAC ID: 7719912070 Enrollment ID: I20051006000121 |
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