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General NPI Number Information
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NPI Number | 1275668972
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Entity Type | Individual
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Provider Name | RACHAEL CLARK SLP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1051 LANTRIP RD
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City | SHERWOOD
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State | AR
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Zip | 72120-4161
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Country | US
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Telephone | 501-833-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 3565 AUSTELL RD SW SUITE 11
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City | MARIETTA
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State | GA
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Zip | 30008-5769
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Country | US
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Telephone | 770-319-8000
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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 | 2013AR
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License Number State | AR
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