Clark, Annette L

Clark, Annette L is an individual health care provider with primary practice located at 227 Metro Dr , Jefferson City MO 65109-1134. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Clark, Annette L can be contacted via phone (888) 403-1071.

Contact Information

Primary practice address
227 Metro Dr Jefferson City MO 65109-1134
Phone: (888) 403-1071
Fax: (573) 635-7560
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 000329 Missouri
Behavioral Health & Social Service Providers / Clinical 1041C0700X 000329 Missouri

Profile Details

NPI number 1407832488
LBN Legal business name Clark, Annette L
Credentials MSW, LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 21st, 2005
Last updated Jun 8th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407832488 NPPES
Missouri MEDICAID 496885914

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