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NPI Code Detail

MEDICARE: KENZIE CLARK

MEDICARE: KENZIE CLARK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1437091428
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENZIE CLARK
Provider Business Mailing Address
First Line : 1319 W MAY ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-3505
Country : US
Telephone Number : 316-364-8767
Fax Number :
Provider Business Practice Location Address
First Line : 1319 W MAY ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-3505
Country : US
Telephone Number : 316-364-8767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ KENZIE CLARK ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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