Jade Clark
Behavior Technician in Baltimore, MD. Individual provider (NPI-1).
NPI number1164028833
StatusActive
Last updated in NPPESDec 8, 2020
Details
- NPI
- 1164028833
- Entity type
- Individual (NPI-1)
- Name
- Jade Clark
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 8, 2020
- Certification date
- Dec 8, 2020
- Last updated
- Dec 8, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
1724 Marshall StBaltimore, MD 21230-4819
Phone 312-965-2997
Mailing address
306 N Kensington AveLa Grange Park, IL 60526-1870
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