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NPI Code Detail

MEDICARE: NICOLE CLARK APSW, CSAC

MEDICARE: NICOLE CLARK APSW, CSAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker129325-121WI
2104100000XSocial Worker15777-132WI
3104100000XSocial WorkerSACIT 15578-130WI

General Provider Information

NPI Number : 1093019762
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE CLARK APSW, CSAC
Provider Business Mailing Address
First Line : 2618 N. BREMEN ST.
Second Line :
City : MILWAUKEE
State : WI
Zip : 53121
Country : US
Telephone Number : 414-977-1200
Fax Number : 414-962-2305
Provider Business Practice Location Address
First Line : 2618 N BREMEN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3003
Country : US
Telephone Number : 414-977-1200
Fax Number : 414-962-2305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2011
Last Update Date : 11/25/2014

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Directions to “ NICOLE CLARK APSW, CSAC” Practice Location

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