Active NPI
Stephen Clark, SLP
- Speech-Language Pathologist
- Chino, CA
National Provider Identifier
1902552714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 23404
- Practice address
- 4199 Bernardo CT
Chino, CA 91710-4902 - Phone
- (909) 497-4882
- NPI assigned
- Mar 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 23404 | CA | Primary |
Addresses
Primary practice location
4199 Bernardo CT
Chino, CA 91710-4902
Mailing address
4199 Bernardo CT
Chino, CA 91710-4902
Phone (909) 497-4882
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23404 | Other | CA | SPEECH LANGUAGE PATHOLOGY LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 23404 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646092800000",
"number": "1902552714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4199 BERNARDO CT",
"city": "CHINO",
"state": "CA",
"postal_code": "917104902",
"telephone_number": "909-497-4882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4199 BERNARDO CT",
"city": "CHINO",
"state": "CA",
"postal_code": "917104902",
"telephone_number": "909-497-4882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "STEPHEN",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-01",
"last_updated": "2022-03-01",
"certification_date": "2022-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "23404",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH LANGUAGE PATHOLOGY LICENSE",
"identifier": "23404",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
- Jason Churchwell, PHD
- Jessica I Cifuentes, NP
- Citrus Valley Physician Partners
- Amanda Clark, OTR/L
- Jaylesse Shabri Clark
- Claudia Somoano LMFT a Licensed Marriage and Family Therapy Prof Corp
- Robert Alphus Clinton, M.D.
- Teri Renee Clipps, PH.D.
- Douglas Matthew Cochrane, M.D.
- Cognify Health Speech Pathology Professional Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.