Individual
JENNIFER ANNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
01/11/2018
Last updated
01/11/2018
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