Provider Demographics
NPI:1235269762
Name:CLARKE, LINDA DIANE (MS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 ROAD M
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-7962
Mailing Address - Country:US
Mailing Address - Phone:620-342-3033
Mailing Address - Fax:
Practice Address - Street 1:901 S HAVERHILL RD
Practice Address - Street 2:317 W. DORM
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3225
Practice Address - Country:US
Practice Address - Phone:316-322-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC #117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional