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General NPI Number Information
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NPI Number | 1336671296
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Entity Type | Individual
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Provider Name | MRS. NATALIE M CLARK
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Gender | Female
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 102 GREEN WAVE BOULEVARD DORCHESTER SCHOOL DISTRICT TWO
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-873-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 303 HOUSTON DR
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City | LADSON
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State | SC
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Zip | 29456-6262
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Country | US
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Telephone | 843-323-8897
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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