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General NPI Number Information
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NPI Number | 1336421999
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Entity Type | Individual
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Provider Name | KIMBERLY D CLARK MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1524 LEXINGTON ROAD
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City | CLOVIS
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State | NM
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Zip | 88101-6846
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Country | US
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Telephone | 575-219-9354
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 LEXINGTON RD
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City | CLOVIS
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State | NM
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Zip | 88101-4418
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Country | US
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Telephone | 575-219-9354
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 105425
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License Number State | TX
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