Individual
CHARLES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
368 FOURTH ST, CROSSVILLE, TN 38555-4309
(423) 622-1551
(423) 622-1556
Mailing address
368 FOURTH ST, CROSSVILLE, TN 38555-4309
(423) 622-1551
(423) 622-1556
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1522
TN
Other
Enumeration date
11/19/2012
Last updated
11/19/2012
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