Individual
MS. CHANELLE NICOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37 KINGSWOOD LN, LYNN, MA 01905-3118
(781) 476-3013
Mailing address
37 KINGSWOOD LN, LYNN, MA 01905-3118
(781) 476-3013
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
S64679223
MA
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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