Laura Danae Clark, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

124-140 Issued in WI

Practice address

3007 Harbor LN N Ste 1200
Plymouth, MN 55447-5103

Phone

(612) 439-4650

NPI assigned

Dec 15, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1450137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1891150082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 PRESERVE CT",
            "city": "LITTLE CANADA",
            "state": "MN",
            "postal_code": "551174676",
            "telephone_number": "406-579-5360",
            "fax_number": "920-857-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 HARBOR LN N STE 1200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475103",
            "telephone_number": "612-439-4650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1575 Allouez Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543115639",
            "country_code": "US",
            "telephone_number": "920-857-9041",
            "fax_number": "920-857-3366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LAURA",
        "middle_name": "DANAE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-15",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "124-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CK Quality Home Care Corporation
• Clarity Care LLC
• Courtney Clark
• Jessica Clark
• Kristin Elise Clark, MD
• Michelle Beth Clawson-Stokes, PT
• Nicole Clay, PHARMD
• Clinicarex LLC
• Joran Clute
• Miranda Cobenais, NP

• Behavior Analyst in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Behavior Analyst in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.