Individual
KRISTA RENAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1011 PROFESSIONAL BLVD, DALTON, GA 30720-2506
(706) 226-4623
Mailing address
118 CHERRY BARK WAY UNIT 3, DALTON, GA 30721-1957
(801) 400-9559
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007831
GA
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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