Kelly Ann Clark, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

7401002511 Issued in MI

Practice address

2231 Ellery Ave
Waterford, MI 48327-1107

Phone

(248) 231-3861

NPI assigned

Aug 16, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Complete Rehabilitation and Sports Physical Therapy, PC

  • Physical Therapist
  • Ronkonkoma, NY
  • NPI 1811097306
  NPD (past)
• Comprehab LLC

  • Physical Therapist
  • Gastonia, NC
  • NPI 1407932775

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1013497304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2231 ELLERY AVE",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271107",
            "telephone_number": "248-231-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 ELLERY AVE",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271107",
            "telephone_number": "248-231-3861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 E Davis St",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272155922",
            "country_code": "US",
            "telephone_number": "336-513-8550",
            "fax_number": "743-205-3533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-16",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "3235",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401002511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Ann Cisternino, CPSS
• Brandi Claerhout
• Katie Lenore Clancy, RN
• Clarity Eye Contact, PLLC
• Davita Clark
• Lindsay Marie-Portrey Clark
• Clear Star Wellness and Staffing LLC
• Sheri Anne Clements, PA-C
• Larissa Clemons
• Clinic for Functional Physical Therapy Inc.

• Behavior Analyst in Waterford, MI
• Providers in Waterford, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.