Alicia Mary Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA3674 Issued in FL

Practice address

15800 Beach Walk Blvd Ste 1001
Fort Myers, FL 33908-3388

Phone

(239) 349-3769

NPI assigned

Jul 13, 2023

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 names 1

• Alicia Mary Rubino Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Healthcare Services, Inc

  • Physical Therapist
  • Tampa, FL
  • NPI 1336535988

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1497434740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14721 EDEN ST",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339081642",
            "telephone_number": "239-834-7245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15800 BEACH WALK BLVD STE 1001",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083388",
            "telephone_number": "239-349-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALICIA",
        "middle_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-13",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA3674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "RUBINO",
            "middle_name": "MARY",
            "credential": "MSCCC/SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• City of Palms Chiropractic LLC
• CJM Radiology PA
• CJS Psychotherapy Associates, LLC
• Ckctb, Inc
• Maricarmen Clapp, LMHC
• Allyssa-Ashley Marie Clark, LMT
• Ashley Marie Clark, M.D.
• Aubrey Clark
• Ava L Clark, RMHCI
• Carol D. Clark, ARNP, BC

• Speech-Language Pathologist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.