Maren Alexandra Clark

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

528140 Issued in WI

Practice address

502 Atlas Ave
Madison, WI 53714-3108

Phone

(833) 646-3222

NPI assigned

Sep 15, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Maren Alexandra Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1245845320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 ATLAS AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537143108",
            "telephone_number": "833-646-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 ATLAS AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537143108",
            "telephone_number": "833-646-3222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Whalen Rd",
            "address_purpose": "LOCATION",
            "city": "Verona",
            "state": "WI",
            "postal_code": "535931765",
            "country_code": "US",
            "telephone_number": "888-476-8485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MAREN",
        "middle_name": "ALEXANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-15",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "528140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAREN",
            "last_name": "JOHNSON",
            "middle_name": "ALEXANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jimmy Clark Jr., P.A. - C
• Joshua John Clark
• Kenneth W Clark, PH.D.
• Laura Kathleen Clark, PSY.D.
• Lindsay Clark, PHD
• Meaghan Ann Clark, MD
• Radonna Clark
• Roseanne Clark, PHD
• Ross W Clark, PA-C
• Sharon V Clark, LAT

• Behavior Analyst in Madison, WI
• Providers in Madison, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.