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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANN CLARK M.S.

MEDICARE: MRS. ELIZABETH ANN CLARK M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSL006098LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336365345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANN CLARK M.S.
Provider Business Mailing Address
First Line : 375 N MORELAND ST
Second Line : BOX 245
City : BOBTOWN
State : PA
Zip : 15315
Country : US
Telephone Number : 724-839-7478
Fax Number :
Provider Business Practice Location Address
First Line : 80 OLD NEW SALEM RD
Second Line :
City : UNIONTOWN
State : PA
Zip : 15401-8902
Country : US
Telephone Number : 724-438-8416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. ELIZABETH ANN CLARK M.S.” Practice Location

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