Provider Demographics
NPI:1104039098
Name:CLARK, HELEN PATRICIA (MA, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:PATRICIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DEERWOOD E
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3054
Mailing Address - Country:US
Mailing Address - Phone:949-551-1816
Mailing Address - Fax:
Practice Address - Street 1:23271 VERDUGO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1347
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist