MEDICARE: CLARA CLARKE 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
1	235Z00000X	Speech-Language Pathologist	113964	TX

General Provider Information

NPI Number	:	1649770611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA CLARKE M.S.

Provider Business Mailing Address
First Line	:	2003 BAILEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1509
Country	:	US
Telephone Number	:	713-412-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 BAILEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1509
Country	:	US
Telephone Number	:	713-412-1843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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Directions to “ CLARA CLARKE M.S.” Practice Location

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