Healthcare Provider Details

I. General information

NPI: 1821905357
Provider Name (Legal Business Name): CHERYL RENEE CLARK SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HIGHWAY 67
KEENE TX
76059-1214
US

IV. Provider business mailing address

808 MEADOW VIEW DR
CLEBURNE TX
76033-5964
US

V. Phone/Fax

Practice location:
  • Phone: 817-774-5312
  • Fax:
Mailing address:
  • Phone: 817-313-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number45282
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: