Provider Demographics
NPI:1790110864
Name:KHIN, CLAY CONRAD
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:CONRAD
Last Name:KHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-0666
Mailing Address - Country:US
Mailing Address - Phone:928-862-0612
Mailing Address - Fax:
Practice Address - Street 1:4810 E BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:RIMROCK
Practice Address - State:AZ
Practice Address - Zip Code:86335-6241
Practice Address - Country:US
Practice Address - Phone:928-567-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA81552355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant