Kimberly D Clark, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

105425 Issued in TX

Practice address

1524 Lexington Road
Clovis, NM 88101-6846

Phone

(575) 219-9354

NPI assigned

Sep 9, 2011

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1336421999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 LEXINGTON RD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014418",
            "telephone_number": "575-219-9354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 LEXINGTON ROAD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881016846",
            "telephone_number": "575-219-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "105425",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline O Churchman
• Cynthia Cicero
• City of Clovis (Clovis Fire Department EMS)
• Clarity Mental Health and Wellness
• Haley Clark, PROV LMSW
• Cash A Clifton, LMHC
• Clovis Brace Shop
• Clovis Cardiology Associates LLC (Clovis Cardiology Associates)
• Clovis Chiropractic & Healthcare Center PA
• Clovis Dermatology PA

• Speech-Language Pathologist in Clovis, NM
• Providers in Clovis, 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 Apr 17, 2019; 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.