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NPI Code Detail

MEDICARE: MS. RAE ANN CLARK

MEDICARE: MS. RAE ANN CLARK
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
1104100000XSocial WorkerNV

General Provider Information

NPI Number : 1184436495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RAE ANN CLARK
Provider Business Mailing Address
First Line : 7380 S EASTERN AVE STE 124
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1502
Country : US
Telephone Number : 702-996-7558
Fax Number :
Provider Business Practice Location Address
First Line : 3215 W CHARLESTON BLVD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2182
Country : US
Telephone Number : 702-996-7558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2025
Last Update Date : 01/23/2025

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Directions to “ MS. RAE ANN CLARK ” Practice Location

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