| Doctor Name: | HEATHER J CLARK |
| NPI Number: | 1639425366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., CCC-SLP |
| License Number: | 242002348 |
| Business Practice Address: | 23750 Fm 1314 Rd Porter, TX - 773653713 |
| Business Phone Number: | 2813543383 |
| Business Fax Number: | 2813546750 |
| Mailing Address: | Po Box 9, PORTER |
| State: | TX |
| Postal Code: | 773650009 |
| Phone Number: | 2813543383 |
| Fax Number: | 2813546750 |
| NPI Enumeration Date: | 07/31/2012 |
| NPI Last Update Date: | 05/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 242002348 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| 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 |