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NPI Code Detail

MEDICARE: AUDREY CLARK

MEDICARE: AUDREY CLARK
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 Pathologist113061TX

General Provider Information

NPI Number : 1376025130
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY CLARK
Provider Business Mailing Address
First Line : 7001 BLESSING AVE APT B
Second Line :
City : AUSTIN
State : TX
Zip : 78752-3336
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4501 DUDMAR DR
Second Line :
City : AUSTIN
State : TX
Zip : 78735-6913
Country : US
Telephone Number : 512-892-1131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 08/29/2018

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Directions to “ AUDREY CLARK ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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