Provider Demographics
NPI:1649770611
Name:CLARKE, CLARA (MS)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1509
Mailing Address - Country:US
Mailing Address - Phone:713-412-1843
Mailing Address - Fax:
Practice Address - Street 1:2003 BAILEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1509
Practice Address - Country:US
Practice Address - Phone:713-412-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist