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General NPI Number Information
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NPI Number | 1669965927
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Entity Type | Individual
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Provider Name | ALEXISS CLARKE
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 3001 N GRANVILLE AVE
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City | MUNCIE
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State | IN
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Zip | 47303-2155
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Country | US
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Telephone | 765-748-5116
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Fax |
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Provider Business Mailing Address
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Address Line | 7405 WESTFIELD BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3056
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Country | US
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Telephone | 765-748-5116
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-21-12135
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License Number State | IN
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