Healthcare Provider Details

I. General information

NPI: 1982525978
Provider Name (Legal Business Name): SAVANNAH JEWEL CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 SW 34TH PL
TOPEKA KS
66614-4581
US

IV. Provider business mailing address

5647 SW 34TH PL
TOPEKA KS
66614-4581
US

V. Phone/Fax

Practice location:
  • Phone: 608-855-0324
  • Fax:
Mailing address:
  • Phone: 608-855-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-547734
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: