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NPI Code Detail

MEDICARE: ALEXISS CLARKE

MEDICARE: ALEXISS CLARKE
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
1106E00000XAssistant Behavior Analyst0-21-12135IN

General Provider Information

NPI Number : 1669965927
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXISS CLARKE
Provider Business Mailing Address
First Line : 7405 WESTFIELD BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240-3056
Country : US
Telephone Number : 765-748-5116
Fax Number :
Provider Business Practice Location Address
First Line : 3001 N GRANVILLE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-2155
Country : US
Telephone Number : 765-748-5116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2018
Last Update Date : 12/19/2025

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Directions to “ ALEXISS CLARKE ” Practice Location

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