Sally Marie Clark, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2824 Issued in AL

Practice address

2820 Columbiana Rd
Ste 210
Birmingham, AL 35216-2589

Phone

(205) 979-6800

Fax

(205) 823-5374

NPI assigned

Mar 20, 2009

Last updated

Dec 2, 2016By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empowerme Rehabilitation Wa, PC

  • Multi-Specialty Clinic/Center
  • Issaquah, WA
  • NPI 1821748112

  Speech-Language Pathologist

  Medicare reassignment NPD

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1942441928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 COLUMBIANA RD",
            "address_2": "STE 210",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352162589",
            "telephone_number": "205-979-6800",
            "fax_number": "205-823-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 COLUMBIANA RD",
            "address_2": "STE 210",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352162589",
            "telephone_number": "205-979-6800",
            "fax_number": "205-823-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SALLY",
        "middle_name": "MARIE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-20",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "2824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "511-39634",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158619",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa B Clark, OT
• Michael Dean Clark Jr.
• Myra Clark
• Nicole Renae Clark, LICSW
• Owen Matthew Clark, MD
• Sara Emily Allen Clark, M.D.
• Stephen T Clark, M.D.
• Timothy M. Clark, CRNA
• Walter D Clark, DPM
• Zachary Eugene Clark, M.D.

• Speech-Language Pathologist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Speech-Language Pathologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.