Individual
CORY MICHAEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12701 N MAIN ST, EL MIRAGE, AZ 85335-2600
(623) 217-8544
Mailing address
4525 S COLLEGE AVE, TEMPE, AZ 85282-6905
(602) 373-3136
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA11879
AZ
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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