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General NPI Number Information
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NPI Number | 1659078285
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Entity Type | Individual
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Provider Name | JESSICA CLARK
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Gender | Female
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 3428 W MARKET ST
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City | FAIRLAWN
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State | OH
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Zip | 44333-3339
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Country | US
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Telephone | 330-668-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 608 HAMPSHIRE RD
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City | FAIRLAWN
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State | OH
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Zip | 44333-4240
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Country | US
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Telephone | 740-238-2101
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-41775
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License Number State | OH
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