Clark, Jendaya M

Clark, Jendaya M is an individual health care provider with primary practice located at 1201 Cypress Ter , Rockford IL 61102-3375. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Clark, Jendaya M can be contacted via phone (815) 519-8548.

Contact Information

Primary practice address
1201 Cypress Ter Rockford IL 61102-3375
Phone: (815) 519-8548
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 180.012915 Illinois

Profile Details

NPI number 1346866563
LBN Legal business name Clark, Jendaya M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2020
Last updated Jun 23rd, 2020 - 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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