Kathleen Clark Clark, SPEECH LANGUAGE PATH
Individual provider Active NPI Speech-Language Pathologist · Thendara, NY
NPI 1114176328 · NPPES record last updated Sep 11, 2008
Key facts
- NPI
- 1114176328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 00834-1 (NY)
- Practice address
- 2675 State Route 28
Thendara, NY 13472-0007 - Phone
- (315) 369-3307
- NPI assigned
- Sep 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00834-1 | NY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 00834-1 | NY | Yes |
Addresses
Primary practice location
2675 State Route 28
Thendara, NY 13472-0007
Mailing address
2675 State Route 28
PO Box 7
Thendara, NY 13472-0007
Phone (315) 369-3307
Other providers in Thendara, NY
All providers in Thendara, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.