Individual
TUCKER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6910 SILVERHEEL ST, SHAWNEE, KS 66226-5316
(913) 405-4550
Mailing address
752 N PERSIMMON DR, OLATHE, KS 66061-5965
(785) 764-4028
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-287185
HI
Other
Enumeration date
08/23/2023
Last updated
07/08/2024
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