Healthcare Provider Details

I. General information

NPI: 1619534203
Provider Name (Legal Business Name): CANDACE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W ALGONQUIN RD UNIT 7575
ALGONQUIN IL
60102-1026
US

IV. Provider business mailing address

801 W ALGONQUIN RD UNIT 7575
ALGONQUIN IL
60102-1026
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-4800
  • Fax:
Mailing address:
  • Phone: 847-457-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: