Provider Demographics
NPI:1477708105
Name:CLARK, DEVON A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:DEVON
Other - Middle Name:A
Other - Last Name:ZULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:380 2ND AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5615
Mailing Address - Country:US
Mailing Address - Phone:646-438-7889
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:646-438-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist