Keely Marie Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

19465 Issued in CA

Practice address

11810 Pierce St Ste 200
Riverside, CA 92505-5173

Phone

(951) 808-5850

NPI assigned

Aug 1, 2024

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

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.

• Lucid Speech & Language

  • Speech-Language Pathologist
  • Murrieta, CA
  • NPI 1336240324
  NPD (past)
• Lucid Speech and Language Clinic, Inc.

  • Speech-Language Pathologist
  • Murrieta, CA
  • NPI 1457805251
  NPD (past)

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

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1780413229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11810 PIERCE ST STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925055173",
            "telephone_number": "951-808-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11810 PIERCE ST STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925055173",
            "telephone_number": "951-808-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KEELY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "19465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaiah Daniel Clark
• Jaclyn Clark
• Jacorey Clark
• John Patrick Clark
• Kasimira Clark, CCC-SLP
• Lawrence Erwin Clark, MD
• Mikayla Clark
• Rodney Aaron Clark, RADTI
• Sherrell Clark
• Tatianna Clark

• Speech-Language Pathologist in Riverside, CA
• Providers in Riverside, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.