Most Relevant Information
Provider Data
| NPI Number: | 1003569062 |
| Provider Name: | LESLEY ANN CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/31/2022 |
| Last Updated: | 01/31/2022 |
Provider Practice Location
408 BEDELL AVE
WOODBINE
GA
315693585
Practice Location Phone/Fax
| Phone: | 9124097889 |
| Fax: |
Provider Mailing Location
1201 SHADOWLAWN DR STE 112
SAINT MARYS
GA
315584074
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |