Riley Sue Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP.14916 Issued in OH

Practice address

306 E Whittier Ave
Fairborn, OH 45324-5313

Phone

(937) 479-5590

NPI assigned

Aug 12, 2022

Last updated

Aug 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1134857568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 DEER CREEK DR",
            "city": "VANDALIA",
            "state": "OH",
            "postal_code": "453779452",
            "telephone_number": "937-479-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 E WHITTIER AVE",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453245313",
            "telephone_number": "937-479-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RILEY",
        "middle_name": "SUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-12",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP.14916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citran Xray LLC
• City of Fairborn (Fairborn Fire Department)
• Sara Claar
• Ashley Rae Clark, CASE MANAGER
• Jorie Clark
• Shauna Marie Clevelle, RN
• Lindsey Cline, BCBA
• Mystery Clubb
• Roger Osta Coate, DPT
• Barbara Cobb

• Speech-Language Pathologist in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Speech-Language Pathologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.