Individual
NICHOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
13300 HICKMAN RD STE 110, CLIVE, IA 50325-8616
(515) 987-8835
Mailing address
3418 KINGMAN BLVD APT 2, DES MOINES, IA 50311-3718
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/29/2017
Last updated
07/31/2017
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