Maya R Clark, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP006487 Issued in GA

Practice address

11550 Abercorn St
Savannah, GA 31419-1902

Phone

(912) 927-5096

Fax

(912) 927-5097

NPI assigned

Nov 13, 2007

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

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.

• Glass Therapy, LLC

  • Physical Therapist
  • Savannah, GA
  • NPI 1104096312
  NPD (past)

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1902086358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 DUNNOMAN DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314198125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11550 ABERCORN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314191902",
            "telephone_number": "912-927-5096",
            "fax_number": "912-927-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MAYA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Nicole Clark
• Carly Virginia Clark
• Eric B Clark Jr., DC,CCMA
• Jarlexia Clark, RBT
• Lisa Landers Clark, LPC
• Rebecca Clark
• Shamira Malik Clark, PCT
• Zinobia S Clark
• Eleanor Clarke
• Juliane S Claxton, CCC-SLP

• Speech-Language Pathologist in Savannah, GA
• Providers in Savannah, 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 Nov 13, 2007; 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.