Provider Demographics
NPI:1568036218
Name:CLARK, CHRISTINA ALLISON (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ALLISON
Last Name:CLARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 PLANTATION PINE CIR APT 1234
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5909
Mailing Address - Country:US
Mailing Address - Phone:984-234-1609
Mailing Address - Fax:
Practice Address - Street 1:7315 KRUME CT APT 1238
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7198
Practice Address - Country:US
Practice Address - Phone:984-234-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist