Mary Leann Clark, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2166 Issued in KY

Practice address

192 Bacon Creek Rd
Corbin, KY 40701-8639

Phone

(606) 526-1900

NPI assigned

Apr 4, 2019

Last updated

Apr 4, 2019By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1689136905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 HENSLEY DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411630",
            "telephone_number": "606-682-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 BACON CREEK RD",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407018639",
            "telephone_number": "606-526-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 Hensley Dr",
            "address_purpose": "LOCATION",
            "city": "London",
            "state": "KY",
            "postal_code": "407411630",
            "country_code": "US",
            "telephone_number": "606-682-2778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "505 Hensley Dr",
            "address_purpose": "LOCATION",
            "city": "London",
            "state": "KY",
            "postal_code": "40741",
            "country_code": "US",
            "telephone_number": "606-682-2778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "LEANN",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "2166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thea Andrea Cima, B.S, TCADC
• Kimber Lauren Cinnamon, LPCC
• Elizabeth Ann Clark, MS
• Frank C Clark, MD
• Lisa F Clark, LPCC
• Stacey Clark, TCADC
• Samantha Clawson, PHARMD
• Walter K. Cleary, P.T.
• Rebecca Belle Clemons, MA, LCADC
• Keith A. Clifton, M.D.

• Speech-Language Pathologist in Corbin, KY
• Providers in Corbin, 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 Apr 4, 2019; 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.