Healthcare Provider Details

I. General information

NPI: 1568036218
Provider Name (Legal Business Name): CHRISTINA ALLISON CLARK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

6604 TRUXTON LN
RALEIGH NC
27616-6694
US

V. Phone/Fax

Practice location:
  • Phone: 984-234-1609
  • Fax:
Mailing address:
  • Phone: 984-234-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14769
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: