MEDICARE: EVAN D 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	:	1497687685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN D CLARK

Provider Business Mailing Address
First Line	:	19217 36TH AVE W STE 210
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5751
Country	:	US
Telephone Number	:	657-444-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	19217 36TH AVE W STE 210
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5751
Country	:	US
Telephone Number	:	657-444-9002
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ EVAN D CLARK ” Practice Location

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