Individual
JORIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1750 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6333
(937) 878-8444
Mailing address
3450 CLOVER RIDGE CT APT 301, FAIRBORN, OH 45324-6638
(601) 454-5942
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/21/2018
Last updated
05/21/2018
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