Dominique Jolie Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

05036 Issued in MD

Practice address

12201 Wallace Landing CT
Upper Marlboro, MD 20772-7957

Phone

(240) 417-9810

NPI assigned

Dec 16, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1229385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1265678502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "681 BEVILLE RD",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321191951",
            "telephone_number": "240-417-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 WALLACE LANDING CT",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207727957",
            "telephone_number": "240-417-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DOMINIQUE",
        "middle_name": "JOLIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-16",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146009176",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22004686A",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "05036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citadel Care Givers Inc (Citadel caregivers)
• Citi Health Care Services Inc
• Civility Community Services, Inc
• Clarity Life Enhancement Collective Inc.
• Deborah Y Clark, M.D.
• Tequia Clark
• Khalilah Clarke
• Teko Clavet
• Clear Mind
• CLS Nursing Services

• Speech-Language Pathologist in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Speech-Language Pathologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.