Krystin Louise Clark, MS CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

112024 Issued in TX

Practice address

4300 Mulligan Ave
Mansfield, TX 76063-3475

Phone

(314) 283-6747

NPI assigned

Dec 27, 2009

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

Other names 1

• Krystin Louise Bond Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1261872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1700116647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 MULLIGAN AVE",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633475",
            "telephone_number": "314-283-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MULLIGAN AVE",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633475",
            "telephone_number": "314-283-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRYSTIN",
        "middle_name": "LOUISE",
        "credential": "MS CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-27",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "112024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTIN",
            "last_name": "BOND",
            "middle_name": "LOUISE",
            "credential": "MS CCC SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• City of Mansfield
• Citydoc Urgent Care Center 4, PLLC
• CJB Enterprises LLC
• CKD Hospice & Palliative Care Inc
• Joseph Clark-Thrower
• Sherryl Clark, LPC
• Doris Lewis Claset, LPC
• Clearminds Behavioral Health
• Clearsky Rehabilitation Hospital of Mansfield, LLC
• Tonyua Renee Cleveland, LMSW

• Speech-Language Pathologist in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.