Individual
SHANNON NICHOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 222-6412
(602) 222-6588
Mailing address
16061 S 38TH WAY, PHOENIX, AZ 85048-7377
(480) 893-6648
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
DA 1924
AZ
Other
Enumeration date
01/30/2006
Last updated
07/08/2007
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