Individual
MRS. CONSTANCE M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3840 HULEN ST HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4395
(817) 569-4517
Mailing address
PO BOX 2603 HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4395
(817) 569-4517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
103836
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103836
LICENSE
TX
Enumeration date
07/27/2010
Last updated
07/27/2010
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