Doctor Name: | MRS. STACI M CLARK |
NPI Number: | 1841218732 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP |
License Number: | 3567 |
Business Practice Address: | 355 Oak Grove Rd Spartanburg, SC - 293012537 |
Business Phone Number: | 8645954225 |
Business Fax Number: | 8645954821 |
Mailing Address: | 200 Broughton Dr, GREENVILLE |
State: | SC |
Postal Code: | 296093841 |
Phone Number: | 8642337905 |
Fax Number: | 8642337905 |
NPI Enumeration Date: | 07/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3567 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
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 |