Provider Demographics
NPI:1750644936
Name:CLARK, KAY A (MS IN SPECIAL EDUCA)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS IN SPECIAL EDUCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-1029
Mailing Address - Country:US
Mailing Address - Phone:607-656-7935
Mailing Address - Fax:
Practice Address - Street 1:114 CUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-1029
Practice Address - Country:US
Practice Address - Phone:607-656-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist