Individual
JERILLYN MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6441 W NORVELL BRYANT HWY, CRYSTAL RIVER, FL 34429-9413
(352) 795-1775
(352) 795-6456
Mailing address
6441 W NORVELL BRYANT HWY, CRYSTAL RIVER, FL 34429-9413
(352) 795-1775
(352) 795-6456
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
AS2131
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS2131
HEARING AID LICENSE
FL
Enumeration date
08/20/2006
Last updated
07/09/2007
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