Provider Demographics
NPI:1013706662
Name:CLARK, JAMIRRAH AIJANAE
Entity type:Individual
Prefix:
First Name:JAMIRRAH
Middle Name:AIJANAE
Last Name:CLARK
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 1:4659 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1466
Mailing Address - Country:US
Mailing Address - Phone:402-800-0396
Mailing Address - Fax:402-557-8583
Practice Address - Street 1:4659 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1466
Practice Address - Country:US
Practice Address - Phone:402-800-0396
Practice Address - Fax:402-557-8583
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral