Angel Clark, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP011104 Issued in GA

Practice address

6035 Peachtree Rd Ste C120
Doraville, GA 30360-3234

Phone

(678) 514-3270

NPI assigned

Jul 30, 2020

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

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 and National Provider Directory roles.

• Atlanta Pediatric Therapy, Inc.

  • Early Intervention Provider Agency
  • Chamblee, GA
  • NPI 1578622593
  NPD (past)

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1720697105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 HUNTERS CROSSING LN",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306564857",
            "telephone_number": "678-699-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 PEACHTREE RD STE C120",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303603234",
            "telephone_number": "678-514-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANGEL",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP011104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie Chen
• Fangzhou CHI, LAC, MPH
• Chinese Medical Center, Inc.
• Christie & Caroline, LLC
• Henry Kyungmo Chung, L,AC
• Harold Coleman Jr.
• Compassionate Client Care LLC
• Credencerx Specialty Pharmacy
• Natalie Crouse, M.S. CCC-SLP
• Donna Culver, M.ED., CCC-SLP

• Speech-Language Pathologist in Doraville, GA
• Providers in Doraville, 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 Jul 30, 2020; 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.