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NPI Code Detail

MEDICARE: MS. JANELLE VERONICA CLARK

MEDICARE: MS. JANELLE VERONICA 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
1225700000XMassage TherapistMA 60430644WA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1528489382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANELLE VERONICA CLARK
Provider Business Mailing Address
First Line : 1025 ATLANTIC AVE STE 101
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1188
Country : US
Telephone Number : 510-268-8120
Fax Number :
Provider Business Practice Location Address
First Line : 1025 ATLANTIC AVE STE 101
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1188
Country : US
Telephone Number : 510-268-8120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2013
Last Update Date : 08/03/2021

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Directions to “ MS. JANELLE VERONICA CLARK ” Practice Location

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