Individual
DAYSHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
94-1221 KA UKA BLVD, WAIPAHU, HI 96797-6202
(808) 773-2792
Mailing address
87-107 KAHAU ST, WAIANAE, HI 96792-3650
(808) 778-8421
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-106975
HI
Other
Enumeration date
11/25/2019
Last updated
01/10/2020
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