Michelle Grace Clark, MHS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Grain Valley, MO
NPI 1275935124 · NPPES record last updated Sep 23, 2014
Key facts
- NPI
- 1275935124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2014020191 (MO)
- Practice address
- 640 NW Jefferson St
Grain Valley, MO 64029-8278 - Phone
- (816) 847-8279
- NPI assigned
- Sep 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014020191 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dazzling Speech Therapy, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
309 Park Ln
Unit O
Odessa, MO 64076
Phone (573) 289-5040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2014020191 | MO | Yes |
Addresses
Primary practice location
640 NW Jefferson St
Grain Valley, MO 64029-8278
Mailing address
620 NW Yennie St
Apt. 314
Grain Valley, MO 64029-9362
Phone (573) 289-5040
Other providers in Grain Valley, MO
- Lillian Cassidy
- Center for the Developmentally Disabled
- Alicia Chaloupka
- Andrea Chambers
- Sang Yong Chung
- Jayne Clarkson
- Ella Clyman
- Sarah Grace Coldiron
- Sydney Conchola
- Julia Conner
All providers in Grain Valley, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.