Individual
LAURA DANAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3007 HARBOR LN N STE 1200, PLYMOUTH, MN 55447-5103
(612) 439-4650
Mailing address
459 PRESERVE CT, LITTLE CANADA, MN 55117-4676
(406) 579-5360
(920) 857-3366
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
124-140
WI
Other
Enumeration date
12/15/2015
Last updated
06/10/2022
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