Provider Demographics
NPI:1538059498
Name:CLARKE, EMMA COLLEEN
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:COLLEEN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463155 FL-200
Mailing Address - Street 2:UNIT 12
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097
Mailing Address - Country:US
Mailing Address - Phone:904-849-1625
Mailing Address - Fax:
Practice Address - Street 1:463155 FL-200 UNIT 12
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097
Practice Address - Country:US
Practice Address - Phone:904-849-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist