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General NPI Number Information
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NPI Number | 1962982223
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Entity Type | Individual
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Provider Name | ALYSSA MARIE CLARK M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 401 OAKWOOD BLVD
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City | ROUND ROCK
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State | TX
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Zip | 78681-4067
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Country | US
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Telephone | 512-610-1727
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Fax |
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Provider Business Mailing Address
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Address Line | 632 GABRIEL MILLS DR
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City | ROUND ROCK
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State | TX
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Zip | 78664-7931
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Country | US
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Telephone | 814-440-9443
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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 | 110908
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License Number State | TX
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