Healthcare Provider Details

I. General information

NPI: 1336055664
Provider Name (Legal Business Name): HANNAH D CLARK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W JACKSON BLVD STE 400
CHICAGO IL
60612-3244
US

IV. Provider business mailing address

1645 W JACKSON BLVD
CHICAGO IL
60612-3276
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8258
  • Fax: 312-942-4990
Mailing address:
  • Phone: 312-942-8258
  • Fax: 312-942-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.023156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: