Provider Demographics
NPI:1477865327
Name:CLARK, BRIDGET EILEEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:EILEEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W PARKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4622
Mailing Address - Country:US
Mailing Address - Phone:828-430-3558
Mailing Address - Fax:828-430-3522
Practice Address - Street 1:137 W PARKER RD STE A
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4622
Practice Address - Country:US
Practice Address - Phone:828-430-3558
Practice Address - Fax:828-430-3522
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist