Provider Demographics
NPI:1093479818
Name:CLARK-WHITE, DONNA REE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:REE
Last Name:CLARK-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 E 89TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7004
Mailing Address - Country:US
Mailing Address - Phone:773-449-9961
Mailing Address - Fax:
Practice Address - Street 1:1336 E 89TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7004
Practice Address - Country:US
Practice Address - Phone:773-449-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist