Individual
MRS. AMY J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3609 WESTERN AVE, MATTOON, IL 61938-2040
(217) 234-3821
Mailing address
3609 WESTERN AVE, MATTOON, IL 61938-2040
(217) 234-3821
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146006254
IL
Other
Enumeration date
07/10/2010
Last updated
07/10/2010
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