MEDICARE: M. A. CLARK, INC

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
1	103TC0700X	Clinical Psychologist	071006752	IL

General Provider Information

NPI Number	:	1467634972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. A. CLARK, INC

Provider Business Mailing Address
First Line	:	7358 N LINCOLN AVE STE 170
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1710
Country	:	US
Telephone Number	:	773-430-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	7358 N LINCOLN AVE STE 170
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1710
Country	:	US
Telephone Number	:	773-430-4601
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARY ANNE CLARK
Credential	:	PSY.D
Telephone Number	:	773-430-4601

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	05/03/2024

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