Provider Demographics
NPI:1437354842
Name:CLARK, JOSEPH PATTERSON (MA, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATTERSON
Last Name:CLARK
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FLEMING ST STE D
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4250
Mailing Address - Country:US
Mailing Address - Phone:828-696-2006
Mailing Address - Fax:
Practice Address - Street 1:510 FLEMING ST STE D
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4250
Practice Address - Country:US
Practice Address - Phone:828-696-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5333231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ60593Medicare UPIN
NC2699776Medicare ID - Type UnspecifiedBLUE RIDGE HEARING CARE