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General NPI Number Information
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NPI Number | 1376486696
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Entity Type | Individual
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Provider Name | LEVI ISAAC CLARK
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Gender | Male
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Dates
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Enumeration Date | 04/11/2026
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Last Update Date | 04/11/2026
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Provider Practice Location Address
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Address Line | 4201 ANDERSON AVE STE D110
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City | MANHATTAN
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State | KS
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Zip | 66503-7603
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Country | US
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Telephone | 785-539-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 701 ASH ST
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City | ABILENE
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State | KS
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Zip | 67410-4204
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Country | US
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Telephone | 785-829-3660
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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 | 14221
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License Number State | KS
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