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General NPI Number Information
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NPI Number | 1629220421
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Entity Type | Individual
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Provider Name | CATHERINE CELESTE CLARK M.S., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 52 LOMB MEMORIAL DR
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City | ROCHESTER
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State | NY
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Zip | 14623-5604
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Country | US
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Telephone | 585-475-6354
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Fax | 585-475-7910
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Provider Business Mailing Address
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Address Line | 258 CROSMAN TER
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City | ROCHESTER
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State | NY
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Zip | 14620-1852
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Country | US
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Telephone | 585-475-6354
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Fax | 585-475-7910
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 000947
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License Number State | NY
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