| Doctor Name: | MRS. KELLY THOMAS CLARK |
| NPI Number: | 1306105903 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC-SLP |
| License Number: | 102206 |
| Business Practice Address: | 3406 Fowler Ct Missouri City, TX - 774596366 |
| Business Phone Number: | 7132019902 |
| Business Fax Number: | |
| Mailing Address: | 3406 Fowler Ct, MISSOURI CITY |
| State: | TX |
| Postal Code: | 774596366 |
| Phone Number: | 7132019902 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2012 |
| NPI Last Update Date: | 06/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 102206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| 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 |