Active NPI
Amber S Clark, M.S. CCC-SLP
- Speech-Language Pathologist
- Ontario, ID
National Provider Identifier
1609011592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1821
- Practice address
- 898 SW Fourth Ave.
Ontario, ID 97914-2693 - Phone
- (541) 881-7330
- NPI assigned
- Dec 8, 2008
- Last updated
- Feb 2, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 13019 | OR | |
| Speech-Language Pathologist | 235Z00000X | 1821 | ID | Primary |
Addresses
Primary practice location
898 SW Fourth Ave.
Ontario, ID 97914-2693
Mailing address
290 N Higbee Ave
Idaho Falls, ID 83401-2554
Phone (208) 890-6841
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13019 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233532800000",
"number": "1609011592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "290 N HIGBEE AVE",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834012554",
"telephone_number": "208-890-6841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "898 SW FOURTH AVE.",
"city": "ONTARIO",
"state": "ID",
"postal_code": "979142693",
"telephone_number": "541-881-7330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "AMBER",
"middle_name": "S",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-08",
"last_updated": "2009-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "13019",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "1821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.