Clare Blake Clark, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

KY-2643 Issued in KY

Practice address

1155 Gholson Rd
West Paducah, KY 42086-9738

Phone

(270) 210-3422

Fax

(800) 464-0431

NPI assigned

Mar 12, 2007

Last updated

Jun 2, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1376675710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 GHOLSON RD",
            "city": "WEST PADUCAH",
            "state": "KY",
            "postal_code": "420869738",
            "telephone_number": "270-210-3422",
            "fax_number": "800-464-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 GHOLSON RD",
            "city": "WEST PADUCAH",
            "state": "KY",
            "postal_code": "420869738",
            "telephone_number": "270-210-3422",
            "fax_number": "800-464-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CLARE",
        "middle_name": "BLAKE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "KY-2643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST STEPS PROVIDER-CBIS",
            "identifier": "1890",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tracy Gibson, D.I.
• Noah Heine
• Kayla Klope, DPT
• Johnnie Leon Knight, D.M.D.

• Speech-Language Pathologist in West Paducah, KY
• Providers in West Paducah, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; 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.