Mariola D Clark, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4058 Issued in NM

Practice address

412 N Richardson Ave
Roswell, NM 88201-4731

Phone

(505) 623-2615

Fax

(505) 622-6703

NPI assigned

Apr 17, 2007

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245456409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 FERN DR",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882032580",
            "telephone_number": "505-749-2795",
            "fax_number": "505-622-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 N RICHARDSON AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014731",
            "telephone_number": "505-623-2615",
            "fax_number": "505-622-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARIOLA",
        "middle_name": "D",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "4058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Choices Center for Independent Living Inc.
• Jerri R Citty, PHARM.D., RPH
• City of Roswell Office of Clerk (Roswell Fire Department)
• Don R. Clark, M.D.
• Joella Ruth Clark, LSAA
• Classic Chiropractic Clinic PC
• Brent Clay
• Amanda R Clem
• Maria Clements, COTA/L
• Terri L Clemmons, LPN

• Speech-Language Pathologist in Roswell, NM
• Providers in Roswell, NM by specialty
• Speech-Language Pathologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.