MEDICARE: ERIKA DAWN CLINTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235763681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DAWN CLINTON

Provider Business Mailing Address
First Line	:	11215 HERMITAGE RD STE 201
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-436-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HERMITAGE RD STE 201
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-436-3991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/25/2020

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Directions to “ ERIKA DAWN CLINTON ” Practice Location

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