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Individual

MICHELLE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1527 URBANA RD, SUMMERTON, SC 29148-8929
(803) 485-2317
Mailing address
1329 JAMIE LN, HOMEWOOD, IL 60430-4037

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
146011174
IL
235Z00000X
Speech-Language Pathologist
Primary
5134
SC

Other

Enumeration date
01/20/2016
Last updated
01/20/2016
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