Provider Demographics
NPI:1528671419
Name:CLARK, EMILY CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CHRISTINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:CHRISTINE
Other - Last Name:SCHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1704 W INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2492
Mailing Address - Country:US
Mailing Address - Phone:479-439-6906
Mailing Address - Fax:
Practice Address - Street 1:1704 W INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2492
Practice Address - Country:US
Practice Address - Phone:479-439-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician