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General NPI Number Information
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NPI Number | 1881262863
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Entity Type | Individual
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Provider Name | STEPHANIE BORJAS CLARK PHD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 1422 W WILLOW ST
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City | CHICAGO
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State | IL
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Zip | 60642-8978
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Country | US
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Telephone | 773-998-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 W ADDISON ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-3502
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Country | US
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Telephone | 817-937-3368
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301017737
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2384697
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071010393
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License Number State | IL
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