MEDICARE: MEGAN 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
1	103K00000X	Behavior Analyst		AZ

General Provider Information

NPI Number	:	1760121859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN CLARK

Provider Business Mailing Address
First Line	:	7205 S POWER RD UNIT 100
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-7456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 S POWER RD UNIT 100
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-7456
Country	:	US
Telephone Number	:	480-716-1770
Fax Number	:

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

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	10/18/2023

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Directions to “ MEGAN CLARK ” Practice Location

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