Krista Renae Clark, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP007831 Issued in GA

Practice address

1011 Professional Blvd
Dalton, GA 30720-2506

Phone

(706) 226-4623

NPI assigned

Apr 30, 2012

Last updated

Apr 30, 2012By 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 1

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

Practice roles

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

• John W. Looper Jr. Speech & Hearing Clinic

  dba Looper Speech & Hearing Center

  • Speech-Language Pathologist
  • Dalton, GA
  • NPI 1720098536
  NPD (past)
• Galen Medical Group, PC

  • Internal Medicine Physician
  • Hixson, TN
  • NPI 1346250057
  NPD (past)

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1629336490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 CHERRY BARK WAY UNIT 3",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307211957",
            "telephone_number": "801-400-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202506",
            "telephone_number": "706-226-4623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTA",
        "middle_name": "RENAE",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP007831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lynn Clark, MS, ATC
• Janae Alise Clark, APRN
• Jane S. Clark
• Jasmine Clark
• Jennifer Kathleen Clark, LCSW
• Toby Johnson Clarkson, DMD
• Kelly Elaine Cline, CPNP-PC
• Callie Cobb, CRNA
• Holly Michelle Cochran, FNP-C
• Susan Cockburn, CNM

• Speech-Language Pathologist in Dalton, GA
• Providers in Dalton, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.