Individual
LATASHA NICHOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1918 MECHANICSBURG RD, SPRINGFIELD, OH 45503-3147
(937) 399-6101
(937) 399-6609
Mailing address
801 S CENTER ST, SPRINGFIELD, OH 45506-2213
(937) 536-2755
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/12/2024
Last updated
01/12/2024
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