Provider Demographics
NPI:1942956602
Name:CLARK, PATRICIA KAYTE (HA 61144575)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAYTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:HA 61144575
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2508
Mailing Address - Country:US
Mailing Address - Phone:509-684-2120
Mailing Address - Fax:509-684-3260
Practice Address - Street 1:710 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2508
Practice Address - Country:US
Practice Address - Phone:509-684-2120
Practice Address - Fax:509-684-3260
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61144575231HA2500X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier