Individual
ELLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
567 N AND SOUTH RD, UNIVERSITY CITY, MO 63130-3951
(314) 380-3088
Mailing address
567 N AND SOUTH RD, UNIVERSITY CITY, MO 63130-3951
(314) 380-3088
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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