Doctor Name: | JEANETTE CLARKE |
NPI Number: | 1164799870 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP, TSSLD |
License Number: | 021512 |
Business Practice Address: | 2386 Morris Ave Apt. 5e Bronx, NY - 104686645 |
Business Phone Number: | 6462834353 |
Business Fax Number: | |
Mailing Address: | Po Box 431, MOUNT VERNON |
State: | NY |
Postal Code: | 105520431 |
Phone Number: | 6462834353 |
Fax Number: | |
NPI Enumeration Date: | 11/23/2011 |
NPI Last Update Date: | 01/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 021512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |