Clark, Sue

Clark, Sue is an individual health care provider with primary practice located at 507 E Armstrong Ave Regional Development Center, Peoria IL 61603-3201. She recently has only one registered license in Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, which is considered as her primary health care specialty. Clark, Sue can be contacted via phone (309) 681-6960.

Contact Information

Primary practice address
507 E Armstrong Ave Regional Development Center Peoria IL 61603-3201
Phone: (309) 681-6960
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics 2080P0006X Illinois

Profile Details

NPI number 1174597371
LBN Legal business name Clark, Sue
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Jul 9th, 2007 - about 19 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 1174597371 NPPES
Illinois Other 07215036 BCBS
Illinois Other IL01Z4 BCBS

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