Provider Demographics
NPI:1871859454
Name:CLARK, LURALEE LANDER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LURALEE
Middle Name:LANDER
Last Name:CLARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CYPRESS GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5962
Mailing Address - Country:US
Mailing Address - Phone:702-259-9117
Mailing Address - Fax:
Practice Address - Street 1:7401 CYPRESS GROVE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-5962
Practice Address - Country:US
Practice Address - Phone:702-259-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist