Individual
SARA C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
2519 E 10TH ST STE A, ANDERSON, IN 46012-4464
(317) 527-5437
Mailing address
1824 TOUBY PIKE STE B, KOKOMO, IN 46901-2573
(765) 628-7400
(855) 940-0177
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-39559
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300036367
—
IN
Enumeration date
10/15/2015
Last updated
03/19/2020
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