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General NPI Number Information
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NPI Number | 1528524162
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Entity Type | Individual
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Provider Name | KIANA M CLERKLEY
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Gender | Female
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 1356 RIDDER PARK DR
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City | SAN JOSE
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State | CA
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Zip | 95131-2313
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Country | US
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Telephone | 669-304-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 CRYER PL
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City | HAYWARD
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State | CA
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Zip | 94545-3064
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Country | US
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Telephone | 510-393-4055
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 111026
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License Number State | CA
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