Individual
JASMEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
369 CONARROE ST, PHILADELPHIA, PA 19128-4806
(610) 816-1187
Mailing address
369 CONARROE ST, PHILADELPHIA, PA 19128-4806
(610) 816-1187
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BH005211
PA
Other
Enumeration date
06/09/2023
Last updated
06/10/2023
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