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NPI Code Detail

MEDICARE: WALTER LEIGHTON CLARK LCSW

MEDICARE:   WALTER LEIGHTON CLARK  LCSW
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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1730301318
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER LEIGHTON CLARK LCSW
Provider Business Mailing Address
First Line : 937 N WALNUT AVE
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-5446
Country : US
Telephone Number : 847-259-3555
Fax Number : 847-259-5124
Provider Business Practice Location Address
First Line : 1845 E RAND RD
Second Line : SUITE 106
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-4356
Country : US
Telephone Number : 847-259-3555
Fax Number : 847-259-5124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 07/08/2007

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Directions to “ WALTER LEIGHTON CLARK LCSW” Practice Location

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