Provider Demographics
NPI:1386874147
Name:CLARK, HILLARY WHITAKER (PSYD)
Entity type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:WHITAKER
Last Name:CLARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99179
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-0179
Mailing Address - Country:US
Mailing Address - Phone:360-908-8491
Mailing Address - Fax:253-581-1232
Practice Address - Street 1:10209 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE A-5
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2320
Practice Address - Country:US
Practice Address - Phone:253-581-1231
Practice Address - Fax:253-581-1232
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60021419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical