Individual
JILL M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
147 TRAILSIDE CIR, HIRAM, GA 30141-3277
(229) 873-1535
Mailing address
147 TRAILSIDE CIR, HIRAM, GA 30141-3277
(229) 873-1535
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006990
GA
Other
Enumeration date
05/23/2012
Last updated
10/25/2019
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