HALEY R CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****88

License Status

ACTIVE

Business

First Name

HALEY

Middle

Last Name

CLARK

Business Name

HALEY R CLARK

Original Issue Date

12/07/2021

Effective Date

01/23/2026

Expiration Date

03/01/2028

City

PARK RIDGE

State

Zip

60068

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/23/2026