Individual
CANDACE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 NOBLE DR, FORT WAYNE, IN 46825-5544
(260) 420-9332
Mailing address
601 NOBLE DR, FORT WAYNE, IN 46825-5544
(260) 420-9332
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/14/2025
Last updated
03/14/2025
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