Healthcare Provider Details

I. General information

NPI: 1134385933
Provider Name (Legal Business Name): KRISTEN M CLARK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7629 E PINNACLE PEAK RD STE 118
SCOTTSDALE AZ
85255-6292
US

IV. Provider business mailing address

7629 E PINNACLE PEAK RD STE 118
SCOTTSDALE AZ
85255-6292
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-3823
  • Fax: 480-701-8604
Mailing address:
  • Phone: 602-283-3823
  • Fax: 480-701-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA1316
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA1316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: