MEDICARE: ALIYAH 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1447104542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIYAH CLARK

Provider Business Mailing Address
First Line	:	4500 BAYMEADOWS RD APT 47
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-5104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 BAYMEADOWS RD APT 47
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-5104
Country	:	US
Telephone Number	:	314-922-0123
Fax Number	:

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

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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