Michaela Breanne Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

119441 Issued in TX

Practice address

400 W Stan Schlueter Loop
Killeen, TX 76542-3839

Phone

(254) 336-2150

NPI assigned

Aug 23, 2022

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1215656236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 TRIMMIER RD APT 18107",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765426054",
            "telephone_number": "903-235-6639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W STAN SCHLUETER LOOP",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765423839",
            "telephone_number": "254-336-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAELA",
        "middle_name": "BREANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "119441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Killeen, Texas
• Reeser Leevon Clare, APRN-CNP
• Anjela Clark, LMFT
• Maliyah Clark
• Mary Suann Clark
• Robert Damian Clark, PH.D.
• Yvonne Clark, NP
• Georgione Clarke
• Kelsey Clarke
• Lakeisha Lashon Marie Clay

• Speech-Language Pathologist in Killeen, TX
• Providers in Killeen, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.