Individual
GRACE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 E 15TH ST STE 800B, EDMOND, OK 73013-6682
(405) 455-6868
Mailing address
1900 E 15TH ST STE 800B, EDMOND, OK 73013-6682
(405) 455-6868
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
05/16/2025
Last updated
05/16/2025
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