Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1013335447 |
---|---|
Provider Name | Patricia Clark |
First Address | Fresno, CA 93722-6119 |
Second Address | Fresno, CA 93722-6119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |