Stephanie Borjas Clark, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071010393 Issued in IL

Practice address

1422 W Willow St
Chicago, IL 60642-8978

Phone

(773) 998-8500

NPI assigned

Jun 15, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Dr. Stephanie Borjas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1881262863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 W ADDISON ST APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133502",
            "telephone_number": "817-937-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 W WILLOW ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606428978",
            "telephone_number": "773-998-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "middle_name": "BORJAS",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301017737",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IL",
            "license": "2384697",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071010393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "BORJAS",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sharon Clark
• Shonda T Clark, NP
• Shoshana Leonie Clark
• Stacy Clark, PH.D.
• Stephanie Clark, LCPC
• Susan Leighton Clark, LCSW
• Therese Michelle Clark, DPT
• Timetra Diane Clark, FNP-BC
• William M Clark Jr., M.D.
• Alison Claire Clarke, FNP-C

• Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.