Individual
MRS. SHANI CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS SLP
Contact information
Practice address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
(770) 923-3100
Mailing address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET001624
GA
Other
Enumeration date
01/30/2011
Last updated
01/30/2011
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