MEDICARE: SHERRIE CLINKSCALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063292068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRIE CLINKSCALE

Provider Business Mailing Address
First Line	:	1715 GWYNN OAK AVE
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-5280
Country	:	US
Telephone Number	:	443-314-8564
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7611
Country	:	US
Telephone Number	:	443-314-8564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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Directions to “ SHERRIE CLINKSCALE ” Practice Location

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