Active NPI
Cynthia Clark
- Speech-Language Pathologist
- Los Angeles, CA
National Provider Identifier
1265737761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5862
- Practice address
- 1111 W 6TH St Ste 111
Los Angeles, CA 90017-1823 - Phone
- (323) 404-1027
- Fax
- (323) 340-8298
- NPI assigned
- Jan 14, 2011
- 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 | 5862 | CA | Primary |
Addresses
Primary practice location
1111 W 6TH St Ste 111
Los Angeles, CA 90017-1823
Mailing address
625 Fair Oaks Ave Ste 200
South Pasadena, CA 91030-2694
Phone (323) 341-5580
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 |
|---|---|---|---|
| 5862 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470960000000",
"number": "1265737761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 FAIR OAKS AVE STE 200",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910302694",
"telephone_number": "323-341-5580",
"fax_number": "323-340-8298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 W 6TH ST STE 111",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171823",
"telephone_number": "323-404-1027",
"fax_number": "323-340-8298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CYNTHIA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-14",
"last_updated": "2016-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "5862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.