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NPI Code Detail

MEDICARE: AMORELLE CLARKE

MEDICARE: AMORELLE CLARKE
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-20-113088OTHERBACB
210206473OTHEROROREGON BARB RBAI

General Provider Information

NPI Number : 1841824000
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMORELLE CLARKE
Provider Business Mailing Address
First Line : 5457 SW CANYON CT
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2401
Country : US
Telephone Number : 503-303-7212
Fax Number :
Provider Business Practice Location Address
First Line : 5457 SW CANYON CT
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2401
Country : US
Telephone Number : 503-303-7212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2020
Last Update Date : 02/26/2020

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Directions to “ AMORELLE CLARKE ” Practice Location

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