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General NPI Number Information
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NPI Number | 1164219341
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Entity Type | Individual
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Provider Name | JACLYN CLARK
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 2300 MARKET ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-2123
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Country | US
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Telephone | 951-624-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 W LINGARD ST
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City | LANCASTER
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State | CA
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Zip | 93536-8383
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Country | US
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Telephone | 661-406-6494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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