# PROF. JACKIE LEAH CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1417951484
- **Gender:** F
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 10/28/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 66993 | CSHCN | TX |