NPIMap

Individual provider Active NPI

Kathryn Gore Clark, CCC-SLP

  • Speech-Language Pathologist
  • Fort Rucker, AL
National Provider Identifier
1760606040
Registry record updated Mar 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2820 Issued in AL
Practice address
301 Andrews Avenue
Edis
Fort Rucker, AL 36362
Phone
(808) 772-1393
NPI assigned
Apr 11, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP 955 HI
Speech-Language Pathologist 235Z00000X 2820 AL Primary

Addresses

Primary practice location

301 Andrews Avenue
Edis
Fort Rucker, AL 36362

Mailing address

112 N Harris Dr
Fort Rucker, AL 36362-2338
Phone (808) 772-1393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SP 955HIMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237420800000",
    "number": "1760606040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N HARRIS DR",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363622338",
            "telephone_number": "808-772-1393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ANDREWS AVENUE",
            "address_2": "EDIS",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "36362",
            "telephone_number": "808-772-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHRYN",
        "middle_name": "GORE",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2009-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "HI",
            "license": "SP 955",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "2820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Rucker, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.