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Individual

MRS. BOBBIE JEAN CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., CCC/SLP

Contact information

Practice address
811 PARK ST, THERMOPOLIS, WY 82443-2239
(307) 921-1535
Mailing address
811 PARK ST, THERMOPOLIS, WY 82443-2239
(307) 921-1535

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-465
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
315047
BCBS
WY
Enumeration date
06/21/2007
Last updated
05/07/2012
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