Provider Demographics
NPI:1285808188
Name:CLARK, ROY ELLIS (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ELLIS
Last Name:CLARK
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4473
Mailing Address - Country:US
Mailing Address - Phone:812-669-1490
Mailing Address - Fax:812-669-1491
Practice Address - Street 1:2345 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4473
Practice Address - Country:US
Practice Address - Phone:812-669-1490
Practice Address - Fax:812-669-1491
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002042237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter