Provider Demographics
NPI:1255683330
Name:CLARK, DEBRA ASHLEY (AU,D)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ASHLEY
Last Name:CLARK
Suffix:
Gender:F
Credentials:AU,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W 25TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2085
Mailing Address - Country:US
Mailing Address - Phone:800-854-2772
Mailing Address - Fax:
Practice Address - Street 1:41 W 25TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2085
Practice Address - Country:US
Practice Address - Phone:800-854-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01922231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004112OtherPROFESSIONAL LICENSE