Individual
MARIOLA D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
412 N RICHARDSON AVE, ROSWELL, NM 88201-4731
(505) 623-2615
(505) 622-6703
Mailing address
1004 FERN DR, ROSWELL, NM 88203-2580
(505) 749-2795
(505) 622-6703
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4058
NM
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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