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General NPI Number Information
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NPI Number | 1316851694
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Entity Type | Individual
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Provider Name | MS. CHASSITTI CLARK
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Gender | Female
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 12907 E SAHUARO DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-4449
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Country | US
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Telephone | 323-493-0517
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Fax |
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Provider Business Mailing Address
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Address Line | 202 JUNCTION RD APT 202
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City | MADISON
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State | WI
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Zip | 53717-2618
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Country | US
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Telephone | 414-393-7055
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NULL
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