SAM BURK CLARK (NPI# 1891395422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891395422 |
| Entity Type | Individual |
| Full Name | SAM BURK CLARK |
| Practice Address |
515 S. 700 E Suite 2a Salt Lake City UT 84102-2142 |
| Practice Telephone | 8019354171 |
| Practice Fax Number | 8019354946 |
| Mailing Telephone | 8019354171 |
| Mailing Fax Number | 8019354946 |
| Enumeration Date | 2020-11-01 |
| Last Update Date | 2020-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 515 S. 700 E, Suite 2a, Salt Lake City, UT 841022142 | 8019354171 | 8019354946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225645617 | Sam Jo Clark | Behavior Technician | 1424 S Main St, Adrian, MI 49221-4309 | 2020-09-29 |
| Street Address |
515 S. 700 E SUITE 2A |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102-2142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| Find all providers in zip 84102 | ||||
| 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 |
|---|---|---|---|---|
| 1235738121 | Jacob Craig Chandler | Behavior Technician | 1253 E 200 S, Salt Lake City, UT 84102-2601 | 2020-10-21 |
| 1194323709 | Cidney Judkins | Behavior Technician | 2267 E 6720 S, Salt Lake City, UT 84121-3221 | 2020-10-15 |
| 1174130678 | Hannah Clare Hebertson | Behavior Technician | 1258 E Wood Ave, Salt Lake City, UT 84105-2516 | 2020-09-29 |
| 1881200210 | Christina Paries | Behavior Technician | 318 S 600 E Apt 4, Salt Lake City, UT 84102-4020 | 2020-09-21 |
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1437776564 | Nataly A Welch | Behavior Technician | 505 S 900 W, Salt Lake City, UT 84104-1302 | 2020-07-06 |
| 1992328835 | Danielle Elizabeth Jones | Behavior Technician | 2767 S Filmore St, Salt Lake City, UT 84106-3544 | 2020-05-27 |
| 1114551025 | Tina Marie Williamson | Behavior Technician | 515 S 700 E Ste A, Salt Lake City, UT 84102-2801 | 2020-02-29 |
| 1619517042 | Kischel Mary Sutton | Behavior Technician | 515 S 700 E Ste 2, Salt Lake City, UT 84102-2801 | 2020-01-14 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
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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.