Active NPI
Gabriele A Clark, SLP
- Speech-Language Pathologist
- Lackawanna, NY
National Provider Identifier
1205212461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 024825
- Practice address
- 678 Ridge Rd Apt 6
Lackawanna, NY 14218-1540 - Phone
- (315) 575-2633
- NPI assigned
- Aug 10, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 024825 | NY | Primary |
Addresses
Primary practice location
678 Ridge Rd Apt 6
Lackawanna, NY 14218-1540
Mailing address
678 Ridge Rd Apt 6
Lackawanna, NY 14218-1540
Phone (315) 575-2633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024825 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439164800000",
"number": "1205212461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "678 RIDGE RD APT 6",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142181540",
"telephone_number": "315-575-2633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "678 RIDGE RD APT 6",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142181540",
"telephone_number": "315-575-2633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GABRIELE",
"middle_name": "A",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-10",
"last_updated": "2015-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "024825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackawanna, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.