Provider Demographics
NPI:1376906420
Name:CLARK, KERRIANNE MARIA (AUD)
Entity Type:Individual
Prefix:DR
First Name:KERRIANNE
Middle Name:MARIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 TRAFORD LN STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1661
Mailing Address - Country:US
Mailing Address - Phone:703-536-1666
Mailing Address - Fax:703-522-2483
Practice Address - Street 1:8314 TRAFORD LN STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1661
Practice Address - Country:US
Practice Address - Phone:703-536-1666
Practice Address - Fax:703-522-2483
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002111237600000X
VA2201001627231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter