Provider Demographics
NPI:1437857331
Name:CLARK, LINDA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N 5TH PL
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1175
Mailing Address - Country:US
Mailing Address - Phone:563-320-0232
Mailing Address - Fax:
Practice Address - Street 1:608 N 5TH PL
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1175
Practice Address - Country:US
Practice Address - Phone:563-320-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150008091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker