Kaela Ann Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14792 Issued in NC

Practice address

3901 Wrightsville Ave Ste 120
Wilmington, NC 28403-6256

Phone

(980) 521-4301

NPI assigned

Jun 13, 2021

Sex

Female

Sole proprietor

No

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)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastline Therapy Group, LLC

  • Speech-Language Pathologist
  • Wilmington, NC
  • NPI 1730681388
  NPD
• Coastal Speech and Reading Center

  • Speech-Language Pathologist
  • Lumberton, NC
  • NPI 1649626466
  NPD (past)

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

{
    "created_epoch": "1623542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1205404621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9804",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274290804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 WRIGHTSVILLE AVE STE 120",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036256",
            "telephone_number": "980-521-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAELA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-13",
        "last_updated": "2023-02-15",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "14792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emilie Clark
• Frances Ellison Clark, MS, RDN/LDN
• Gwendolyn D Clark, LCSW
• Howard Russell Clark, RPH
• Jesse D Clark, DMD
• Lauren Marie Clark, MSW, LCSWA
• Leslie Clark, PT
• Makenna Katherine Clark, M.S-SLP
• Martin L Clark, LMT
• Nancy Suzanne Clark, PT

• Speech-Language Pathologist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.