NPI 1356365316

James a Clark, CADCIII

Practitioner Addiction (Substance Use Disorder) Counselor Fort Atkinson, WI

Practice location

Address: 509 McMillen St, Fort Atkinson, WI 53538-1263
Phone: (920) 563-7995
Fax: (920) 568-6047

Registered specialties

Addiction (Substance Use Disorder) Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YA0400X Licence 484 (WI)

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Registry record

NPI: 1356365316
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Jul 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.