Individual
JOHN RUSSELL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS SLPCCC
Contact information
Practice address
7811 COBDEN RD, LAVEROCK, PA 19038-7257
(215) 233-2504
(215) 233-2504
Mailing address
7811 COBDEN RD, LAVEROCK, PA 19038-7257
(215) 233-2504
(215) 233-2504
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL006211L
PA
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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