Individual
ANDREA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2483 15TH ST NW STE A, NEW BRIGHTON, MN 55112-5604
(918) 639-9067
Mailing address
713 CARPENTER RD, NOCONA, TX 76255-6820
(918) 639-9067
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/05/2023
Last updated
05/05/2023
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