Healthcare Provider Details

I. General information

NPI: 1548198948
Provider Name (Legal Business Name): ROBERT DAVID CLARK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9016 EWING AVE
EVANSTON IL
60203-1909
US

IV. Provider business mailing address

9016 EWING AVE
EVANSTON IL
60203-1909
US

V. Phone/Fax

Practice location:
  • Phone: 847-702-9067
  • Fax: 847-674-7218
Mailing address:
  • Phone: 847-702-9067
  • Fax: 847-674-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.011257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: