Individual
DOMINIQUE JOLIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12201 WALLACE LANDING CT, UPPER MARLBORO, MD 20772-7957
(240) 417-9810
Mailing address
681 BEVILLE RD, SOUTH DAYTONA, FL 32119-1951
(240) 417-9810
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
05036
MD
235Z00000X
Speech-Language Pathologist
146009176
IL
235Z00000X
Speech-Language Pathologist
22004686A
IN
Other
Enumeration date
12/16/2008
Last updated
08/03/2018
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