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Individual
GABRIELLE L CLARK
Active
Individual
GABRIELLE L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006568A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063220046
MEDICARE PTAN
IN
01
—
264430A72
MEDICARE PTAN
IN
05
—
300034682
—
IN
01
—
Q00139223
RAILROAD PTAN
IN
01
—
Q00478549
RAILROAD PTAN
IN
Enumeration date
01/19/2020
Last updated
09/27/2023
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