Provider Demographics
NPI:1164232427
Name:CLARKE, BECKY LYNN (MRC)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DEON DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3069
Mailing Address - Country:US
Mailing Address - Phone:986-869-8383
Mailing Address - Fax:
Practice Address - Street 1:920 DEON DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3069
Practice Address - Country:US
Practice Address - Phone:986-869-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner