Individual
MRS. AMY SUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
6 ERICA CT, PUEBLO, CO 81001-1074
(719) 369-6862
(719) 941-7314
Mailing address
6 ERICA CT, PUEBLO, CO 81001-1074
(719) 369-6862
(719) 941-7314
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP.0000301
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95037071
—
CO
Enumeration date
01/02/2011
Last updated
10/13/2020
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