Active NPI
Stephanie Elaine Clark, AU.D., CCC-A
- Audiologist
- Phoenix, AZ
National Provider Identifier
1700864733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- DA1137
- Practice address
- 4045 E Bell Rd Ste 135
Phoenix, AZ 85032-2234 - Phone
- (602) 277-8558
- NPI assigned
- Jan 9, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | DA1137 | AZ | Primary |
Addresses
Primary practice location
4045 E Bell Rd Ste 135
Phoenix, AZ 85032-2234
Mailing address
1230 E Audrey LN
Phoenix, AZ 85022-1243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 614728 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DA1137 | AZ | MD | Audiologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611705600000",
"number": "1700864733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 E AUDREY LN",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850221243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4045 E BELL RD STE 135",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850322234",
"telephone_number": "602-277-8558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "STEPHANIE",
"middle_name": "ELAINE",
"name_prefix": "Dr.",
"credential": "AU.D., CCC-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-09",
"last_updated": "2021-01-27",
"certification_date": "2021-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "AZ",
"license": "DA1137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "614728",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.