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NPI Code Detail

MEDICARE: NICOLE CLARK SLP

MEDICARE: NICOLE CLARK SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP#3053AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112148849OTHERARAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
2SP#3053OTHERARARKANSAS BOARD OF EXAMINERS SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY

General Provider Information

NPI Number : 1942585682
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE CLARK SLP
Provider Business Mailing Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number : 479-636-4587
Provider Business Practice Location Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number : 479-636-4587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2011
Last Update Date : 10/13/2011

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Directions to “ NICOLE CLARK SLP” Practice Location

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