Provider Demographics
NPI:1730301318
Name:CLARK, WALTER LEIGHTON (LCSW)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:LEIGHTON
Last Name:CLARK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5446
Mailing Address - Country:US
Mailing Address - Phone:847-259-3555
Mailing Address - Fax:847-259-5124
Practice Address - Street 1:1845 E RAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4356
Practice Address - Country:US
Practice Address - Phone:847-259-3555
Practice Address - Fax:847-259-5124
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical