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NPI Code Detail

MEDICARE: MRS. JULIE CLARK ST

MEDICARE: MRS. JULIE CLARK ST
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 PathologistSP.7899OH

General Provider Information

NPI Number : 1336447663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE CLARK ST
Provider Business Mailing Address
First Line : 6276 PLATTSBURG ROAD
Second Line :
City : SOUTH CHARLESTON
State : OH
Zip : 45368-8801
Country : US
Telephone Number : 937-717-6741
Fax Number : 937-284-8186
Provider Business Practice Location Address
First Line : 6276 PLATTSBURG RD
Second Line :
City : SOUTH CHARLESTON
State : OH
Zip : 45368-8801
Country : US
Telephone Number : 937-717-6741
Fax Number : 937-284-8186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 03/10/2011

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Directions to “ MRS. JULIE CLARK ST” Practice Location

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