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General NPI Number Information
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NPI Number | 1104799477
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Entity Type | Individual
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Provider Name | KASEY CLARKE
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3440 SAINT JOHNS PKWY STE 1050
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City | SANFORD
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State | FL
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Zip | 32771-6763
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Country | US
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Telephone | 407-878-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 718 SUGAR BAY WAY UNIT 202
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City | LAKE MARY
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State | FL
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Zip | 32746-6506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ13032
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License Number State | FL
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