Provider Demographics
NPI:1235480187
Name:CLARK, CYNTHEA (BC-HIS)
Entity Type:Individual
Prefix:
First Name:CYNTHEA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 S PECOS RD STE 21A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7155
Mailing Address - Country:US
Mailing Address - Phone:725-333-4327
Mailing Address - Fax:702-921-6370
Practice Address - Street 1:8935 S PECOS RD STE 21A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7155
Practice Address - Country:US
Practice Address - Phone:725-333-4327
Practice Address - Fax:702-921-6370
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-513237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV23Medicaid