Individual
KATHLEEN WEST-CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.C.D.
Contact information
Practice address
100 W KENTUCKY AVE, VIVIAN, LA 71082-2416
(318) 465-7784
Mailing address
1910 AUDUBON PL, SHREVEPORT, LA 71105-3426
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2746
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2746
LA LIC
LA
Enumeration date
04/01/2022
Last updated
04/01/2022
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