Individual
AMBER S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
898 SW FOURTH AVE., ONTARIO, ID 97914-2693
(541) 881-7330
Mailing address
290 N HIGBEE AVE, IDAHO FALLS, ID 83401-2554
(208) 890-6841
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
13019
OR
235Z00000X
Speech-Language Pathologist
Primary
1821
ID
Other
Enumeration date
12/08/2008
Last updated
02/02/2009
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