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General NPI Number Information
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NPI Number | 1851898233
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Entity Type | Individual
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Provider Name | AMY CLARK LCSW, SAC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 9200 W LOOMIS RD STE 217
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City | FRANKLIN
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State | WI
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Zip | 53132
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Country | US
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Telephone | 414-773-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 W LOOMIS RD STE 217
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City | FRANKLIN
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State | WI
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Zip | 53132-8887
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Country | US
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Telephone | 414-773-4312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16182-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8789-123
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License Number State | WI
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