| Doctor Name: | MICHELE CLARK |
| NPI Number: | 1922134147 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC,SLP |
| License Number: | SLP001439 |
| Business Practice Address: | 245 Lawn Market Sharpsburg, GA - 302771511 |
| Business Phone Number: | 6785910041 |
| Business Fax Number: | 7704633248 |
| Mailing Address: | Po Box 478, TYRONE |
| State: | GA |
| Postal Code: | 302900478 |
| Phone Number: | 6785910041 |
| Fax Number: | 7704633248 |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP001439 |
| 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 |