Healthcare Provider Details

I. General information

NPI: 1760546428
Provider Name (Legal Business Name): MELISSA ANN CLARK MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ANN HATFIELD MCD, CCC-SLP

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

IV. Provider business mailing address

6320 CANOGA AVE FL 15
WOODLAND HILLS CA
91367-2563
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 818-894-2273
  • Fax: 818-357-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2016007409
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1980
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01045600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: