Doctor Name: | MICHELLE GRACE CLARK |
NPI Number: | 1275935124 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHS, CCC-SLP |
License Number: | 2014020191 |
Business Practice Address: | 640 Nw Jefferson St Grain Valley, MO - 640298278 |
Business Phone Number: | 8168478279 |
Business Fax Number: | |
Mailing Address: | 620 Nw Yennie St, Apt. 314 GRAIN VALLEY |
State: | MO |
Postal Code: | 640299362 |
Phone Number: | 5732895040 |
Fax Number: | |
NPI Enumeration Date: | 09/23/2014 |
NPI Last Update Date: | 09/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2014020191 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
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 |