Individual
PEGGY D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
6 TELCOM DR, BANGOR, ME 04401-3072
(207) 941-2850
(207) 941-2852
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP958
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10037581
AMERIGROUP
GA
01
—
344119
WELLCARE
GA
05
—
704575468A
—
GA
Enumeration date
06/24/2005
Last updated
06/15/2021
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