Provider Demographics
NPI:1770820276
Name:CLARKE, PATRICIA ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 WESTWOOD CT
Mailing Address - Street 2:#73
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7227
Mailing Address - Country:US
Mailing Address - Phone:661-472-4977
Mailing Address - Fax:
Practice Address - Street 1:2065 WESTWOOD CT
Practice Address - Street 2:#73
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7227
Practice Address - Country:US
Practice Address - Phone:661-472-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist