Kelly Clark, MS, CCC-SLP
Speech-Language Pathologist, in Joplin, MO. Individual provider (NPI-1).
NPI number1942695325
StatusActive
Last updated in NPPESJun 17, 2022
Details
- NPI
- 1942695325
- Entity type
- Individual (NPI-1)
- Name
- Kelly Clark
- Credential
- MS, CCC-SLP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 1, 2015
- Certification date
- Jun 17, 2022
- Last updated
- Jun 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 2017005866 | MO | Yes |
| 235Z00000X | Speech-Language Pathologist, | 76764 | MA | |
| 235Z00000X | Speech-Language Pathologist, | 3719 | KS |
Practice location
226 N Pearl AveJoplin, MO 64801-2459
Phone 617-699-4334
Mailing address
226 N Pearl AveJoplin, MO 64801-2459
Phone 617-699-4334
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