Healthcare Provider Details

I. General information

NPI: 1578981403
Provider Name (Legal Business Name): LEAH ELIZABETH CLARK ED.S, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 JONES ST
SIOUX CITY IA
51105-1751
US

IV. Provider business mailing address

3127 JONES ST
SIOUX CITY IA
51104-2753
US

V. Phone/Fax

Practice location:
  • Phone: 712-746-7447
  • Fax: 712-525-0036
Mailing address:
  • Phone: 712-259-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2018003232
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number105829
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: