Provider Demographics
NPI:1407443500
Name:CLINKSCALE, TALISHA FRANCESSCA
Entity Type:Individual
Prefix:
First Name:TALISHA
Middle Name:FRANCESSCA
Last Name:CLINKSCALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N ALMA SCHOOL RD APT 1052
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8013
Mailing Address - Country:US
Mailing Address - Phone:602-632-3546
Mailing Address - Fax:
Practice Address - Street 1:3400 N ALMA SCHOOL RD APT 1052
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8013
Practice Address - Country:US
Practice Address - Phone:602-632-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist