Provider Demographics
NPI:1851875207
Name:CLARK, REBECCA SUE (LSCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1727
Mailing Address - Country:US
Mailing Address - Phone:719-289-8743
Mailing Address - Fax:785-734-0447
Practice Address - Street 1:205 E 7TH ST STE 154
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4907
Practice Address - Country:US
Practice Address - Phone:785-734-0447
Practice Address - Fax:620-805-6933
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS055701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical