Provider Demographics
NPI:1417996539
Name:CLARK, LYNNETTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:
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 1:5572 LINKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0288
Mailing Address - Country:US
Mailing Address - Phone:910-907-6982
Mailing Address - Fax:910-907-8485
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER
Practice Address - Street 2:BUILDING 4-2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-6982
Practice Address - Fax:920-907-8485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist