Doctor Name: | MR. JEREMIAH FRANK CLARK |
NPI Number: | 1750656708 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. CCC-SLP |
License Number: | 13589 |
Business Practice Address: | 74 N 3rd St Creswell, OR - 974269649 |
Business Phone Number: | 5412211262 |
Business Fax Number: | |
Mailing Address: | 74 N 3rd St, CRESWELL |
State: | OR |
Postal Code: | 974269649 |
Phone Number: | 5412211262 |
Fax Number: | |
NPI Enumeration Date: | 03/08/2012 |
NPI Last Update Date: | 03/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 13589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
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 |