Provider Demographics
NPI:1558933929
Name:CLARK, ASHLYNN SHA
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:SHA
Last Name:CLARK
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 1:2500 BENNETT AVE APT 1309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7183
Mailing Address - Country:US
Mailing Address - Phone:317-946-0615
Mailing Address - Fax:
Practice Address - Street 1:1621 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6141
Practice Address - Country:US
Practice Address - Phone:972-596-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist