Doctor Name: | VICKI KNOWLES CLARKE |
NPI Number: | 1669541223 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | GA SLP 003536 |
Business Practice Address: | 3166 Cherokee St Nw Suite 101 Kennesaw, GA - 301442883 |
Business Phone Number: | 6782906524 |
Business Fax Number: | 8663846541 |
Mailing Address: | 2841 Patches Ct Nw, KENNESAW |
State: | GA |
Postal Code: | 301525856 |
Phone Number: | 7705908016 |
Fax Number: | 8663846451 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | GA SLP 003536 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |