Individual
DOREEN ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
6600 SIX FORKS RD, STE 202, RALEIGH, NC 27615-6517
(919) 787-4400
(919) 510-0070
Mailing address
401 LYNCHESTER CT, RALEIGH, NC 27615-7301
(919) 846-3652
(919) 510-0070
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3792
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7411594
—
NC
Enumeration date
12/05/2006
Last updated
10/17/2008
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