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NPI Code Detail

MEDICARE: HEATHER CLARK

MEDICARE: HEATHER 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
1106E00000XAssistant Behavior AnalystGA

General Provider Information

NPI Number : 1215688205
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER CLARK
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 GRAND CENTRAL BLVD STE 101
Second Line :
City : POOLER
State : GA
Zip : 31322-4146
Country : US
Telephone Number : 912-244-3305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2022
Last Update Date : 12/05/2025

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Directions to “ HEATHER CLARK ” Practice Location

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