Individual
KELLY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
226 N PEARL AVE, JOPLIN, MO 64801-2459
(617) 699-4334
Mailing address
226 N PEARL AVE, JOPLIN, MO 64801-2459
(617) 699-4334
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2017005866
MO
235Z00000X
Speech-Language Pathologist
3719
KS
235Z00000X
Speech-Language Pathologist
76764
MA
Other
Enumeration date
04/01/2015
Last updated
06/17/2022
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