Amber Clark, MS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Lebanon, KY
NPI 1710247846 · NPPES record last updated Jun 10, 2020
Key facts
- NPI
- 1710247846
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 140756 (KY)
- Practice address
- 60 W Calvary Dr
Lebanon, KY 40033-8421 - Phone
- (270) 779-4143
- NPI assigned
- May 23, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12-001 | KY | MD | Speech-Language Pathologist |
| 140756 | KY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12-001 | KY | |
| Speech-Language Pathologist | 235Z00000X | 140756 | KY | Yes |
Addresses
Primary practice location
60 W Calvary Dr
Lebanon, KY 40033-8421
Mailing address
60 W Calvary Dr
Lebanon, KY 40033-8421
Phone (270) 779-4143
Other practice location 1
105 Laura Sue Humphress Dr
Campbellsville, KY 42718-8899
Phone (270) 465-7768
Other providers in Lebanon, KY
- William Neil Caldwell
- Called to Care, LLC
- Central Kentucky Optometric Associates PSC
- Central Kentucky Rehabilitation, LLC
- Chiropractic Health Center of Lebanon PLLC
- Delanna Leigh Clark
- Heather Lacey Clark
- Clarkson Optometry Midwest Inc
- Ruby Combs
- Communicare Inc
All providers in Lebanon, KY · Speech-Language Pathologist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.