Individual
MRS. KATHRYN GORE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
301 ANDREWS AVENUE, EDIS, FORT RUCKER, AL 36362
(808) 772-1393
Mailing address
112 N HARRIS DR, FORT RUCKER, AL 36362-2338
(808) 772-1393
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2820
AL
235Z00000X
Speech-Language Pathologist
SP 955
HI
Other
Enumeration date
04/11/2007
Last updated
03/19/2009
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