Jeremiah Frank Clark, M.S. CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Creswell, OR
NPI 1750656708 · NPPES record last updated Mar 8, 2012
Key facts
- NPI
- 1750656708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 13589 (OR)
- Practice address
- 74 N 3Rd St
Creswell, OR 97426-9649 - Phone
- (541) 221-1262
- NPI assigned
- Mar 8, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 13589 | OR | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 13589 | OR | Yes |
Addresses
Primary practice location
74 N 3Rd St
Creswell, OR 97426-9649
Mailing address
74 N 3Rd St
Creswell, OR 97426-9649
Phone (541) 221-1262
Other providers in Creswell, OR
- J Kristen Campbell
- Brian Cantoran
- Care Center (Laneco) Inc
- Marco Caturegli
- Children First Therapy LLC
- Victoria Couch
- Amyjean W Coumas
- Creswell SNF Healthcare LLC
- Creswell Wellness Center
- Ashley Delu
All providers in Creswell, OR · Speech-Language Pathologist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2012. 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.