Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-57420 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1003450073 |
---|---|
Provider Name | Ms. Smiljana Vuletic Clark |
First Address | Lake Mary, FL 32746-5028 |
Second Address | St Augustine, FL 32092-4538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2019 |
Last Update Date | 09/02/2022 |