Andrea Clark
Individual provider Active NPI Speech-Language Pathologist · Clinton, AR
NPI 1497941330 · NPPES record last updated Aug 21, 2024
Key facts
- NPI
- 1497941330
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2480 (AR)
- Practice address
- 765 Yellowjacket LN
Clinton, AR 72031-6836 - Phone
- (501) 745-6000
- NPI assigned
- Sep 24, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2480 | AR | Yes |
Addresses
Primary practice location
765 Yellowjacket LN
Clinton, AR 72031-6836
Mailing address
27 Greystone Dr
Greenbrier, AR 72058-9382
Phone (501) 230-6290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164773721 | Medicaid | AR |
Other providers in Clinton, AR
- Carroll Family Practice
- Barry Scott Carroll
- Amber Carter
- Howard Cavender
- Natasha R Chase
- Nichole Deann Clark
- Clinton Butler
- Clinton Butler, LLC
- Clinton Butler, LLC
- Clinton Thriftway Pharmacy
All providers in Clinton, AR · Speech-Language Pathologist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2024. 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.