MEDICARE: ANGELA 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
1	252Y00000X	Early Intervention Provider Agency
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1912722695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CLARKE

Provider Business Mailing Address
First Line	:	3749 N OAK HILL RD
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9277
Country	:	US
Telephone Number	:	217-725-7299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3749 N OAK HILL RD
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9277
Country	:	US
Telephone Number	:	217-725-7299
Fax Number	:

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

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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Directions to “ ANGELA CLARKE ” Practice Location

Language	Start Address	Practice Location

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