Provider Demographics
NPI:1386821346
Name:CLARK, JENNY S (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3250
Mailing Address - Country:US
Mailing Address - Phone:806-359-8974
Mailing Address - Fax:806-359-0506
Practice Address - Street 1:2505 LAKEVIEW DR
Practice Address - Street 2:SUITE 302
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1527
Practice Address - Country:US
Practice Address - Phone:806-358-8974
Practice Address - Fax:806-359-0506
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist