Provider Demographics
NPI:1841747508
Name:PFAU CLARK, ANNA (MS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PFAU CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 LAKE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1192
Mailing Address - Country:US
Mailing Address - Phone:651-784-7007
Mailing Address - Fax:
Practice Address - Street 1:6776 LAKE DR STE 220
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1192
Practice Address - Country:US
Practice Address - Phone:651-784-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist