SAM JO CLARK (NPI# 1225645617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225645617 |
| Entity Type | Individual |
| Full Name | SAM JO CLARK |
| Practice Address |
1424 S Main St Adrian MI 49221-4309 |
| Practice Telephone | 5173121711 |
| Mailing Telephone | 5173121711 |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395422 | Sam Burk Clark | Behavior Technician | 515 S. 700 E, Suite 2a, Salt Lake City, UT 84102-2142 | 2020-11-01 |
| Street Address |
1424 S MAIN ST |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-4309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851788442 | Rachel Laura Richmond | Speech-Language Pathologist | 1424 S Main St, Adrian, MI 49221-4309 | 2015-04-21 |
| 1093315566 | Brooke Catherine Leupp | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-10-26 |
| 1457968828 | Marlayna Nicole Minnick | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1710594197 | Brianna Mckeon | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1457968851 | Alicia Perez | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1003420589 | Marissa Joy Nazareno | Physical Therapist | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-02 |
| 1629680533 | Brittani Aschemeier | Speech-Language Pathologist | 1424 S Main St, Adrian, MI 49221-4309 | 2020-08-21 |
| 1790393411 | Rachel Ann Hoag | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-07-20 |
| 1760090930 | Sidney Ing | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-07-14 |
| 1619594249 | Karrah Leah Vanier | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-06-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
| Find all providers in zip 49221 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912520453 | Storm Sexton | Behavior Technician | 1424 S Main St Ste 3, Adrian, MI 49221-4309 | 2020-05-19 |
| 1174154280 | Angela Slovak | Behavior Technician | 1424 S Main St Ste 2, Adrian, MI 49221-4309 | 2020-01-28 |
| 1992285878 | Hannah Elizabeth Clayton | Behavior Technician | 15415 Nw State Route Aa, Adrian, MO 64720-4890 | 2018-08-20 |
| 1528669165 | Kyle Lynn Brooks | Behavior Technician | 1424 S Main St Ste 3, Adrian, MI 49221-4309 | 2020-11-02 |
| 1093315566 | Brooke Catherine Leupp | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-10-26 |
| 1457968828 | Marlayna Nicole Minnick | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1710594197 | Brianna Mckeon | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1457968851 | Alicia Perez | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| 1790393411 | Rachel Ann Hoag | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-07-20 |
| 1760090930 | Sidney Ing | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-07-14 |
| Find all providers in ADRIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.