CONNIE M CLARK Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149007006

License Status

INACTIVE

Business

First Name

CONNIE M

Last Name

CLARK

Business Name

CONNIE M CLARK

Original Issue Date

04/24/1996

Effective Date

11/25/2003

Expiration Date

11/30/2005

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

12/16/2005