Healthcare Provider Details

I. General information

NPI: 1255264289
Provider Name (Legal Business Name): WILLIAM CLARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ARTHUR RD
WATSONVILLE CA
95076-3701
US

IV. Provider business mailing address

4577 PRESCOTT RD
SOQUEL CA
95073-9737
US

V. Phone/Fax

Practice location:
  • Phone: 831-786-7699
  • Fax:
Mailing address:
  • Phone: 831-295-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: