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Contact Information

ANNETTE L CLARK, MSW, LCSW
227 METRO DR
JEFFERSON CITY, MO65109-1134
 Phone: 888-403-1071
 Fax: 573-635-7560
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for ANNETTE L CLARK · (Female)

NPI Number 1407832488
Status Active
Credentials MSW, LCSW
Entity Individual
Enumeration date 12/21/2005
Last updated 06/08/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 000329
  • MO Medicaid 496885914
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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