Healthcare Provider Details

I. General information

NPI: 1467366609
Provider Name (Legal Business Name): NATALIE MARIE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MONROE ST APT 6
VALPARAISO IN
46383-5758
US

IV. Provider business mailing address

405 MONROE ST APT 6
VALPARAISO IN
46383-5758
US

V. Phone/Fax

Practice location:
  • Phone: 618-707-9507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberC462-6330-3863
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: