Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1063958346 |
---|---|
Provider Name | Ladeshaa Clark |
First Address | Las Vegas, NV 89106 |
Second Address | Las Vegas, NV 89106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2017 |
Last Update Date | 11/01/2017 |