Provider Demographics
NPI:1629364005
Name:ROMERO-CLARK, CAROL A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:ROMERO-CLARK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10048 CALLE CHULITA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1851
Mailing Address - Country:US
Mailing Address - Phone:505-228-2880
Mailing Address - Fax:505-272-4906
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-2455
Practice Address - Fax:505-272-4906
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist