Kaitlyn Maurene Clark, M.S CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA11993 Issued in FL

Practice address

3001 Palm Coast Pkwy SE
Palm Coast, FL 32137-8209

Phone

(386) 446-6060

NPI assigned

May 14, 2018

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": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1740770940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 PALM COAST PKWY SE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378209",
            "telephone_number": "386-446-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 PALM COAST PKWY SE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378209",
            "telephone_number": "386-446-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAITLYN",
        "middle_name": "MAURENE",
        "credential": "M.S CCC SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA11993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Circle of Health Family Practice LLC
• Gregorio Alfonso Cisneros, MD
• Citrine Speech Therapy, LLC
• Bethany Clark, PT, DPT
• Cydney Clark
• Yolanda Clark, LPN
• Amanda Soto Clarke, RN
• Astrid Grace Clarke, MD
• Nayvette Claudio, RBT ASSISSTANT
• Cleetherapy

• Speech-Language Pathologist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; 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.