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General NPI Number Information
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NPI Number | 1992839112
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Entity Type | Individual
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Provider Name | NILA M. CLARK SLP
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 419 N GEIGER ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1342
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Country | US
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Telephone | 812-683-2531
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Fax | 812-683-2531
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Provider Business Mailing Address
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Address Line | 419 N GEIGER ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1342
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Country | US
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Telephone | 812-683-2531
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Fax | 812-683-2531
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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 | 22000444A
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License Number State | IN
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