Provider Demographics
NPI:1336671296
Name:CLARK, NATALIE M
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6262
Mailing Address - Country:US
Mailing Address - Phone:843-323-8897
Mailing Address - Fax:
Practice Address - Street 1:102 GREEN WAVE BOULEVARD
Practice Address - Street 2:DORCHESTER SCHOOL DISTRICT TWO
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-873-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant