Healthcare Provider Details

I. General information

NPI: 1871413328
Provider Name (Legal Business Name): DIONNA RAE CLARK TEMPORARY- LICENSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W 95TH ST STE 100
OVERLAND PARK KS
66212-1434
US

IV. Provider business mailing address

8037 HIGHLAND AVE
KANSAS CITY MO
64131-2317
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-3250
  • Fax: 816-508-3535
Mailing address:
  • Phone: 785-477-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03770-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: