Provider Demographics
NPI:1295057362
Name:CLARK, ANDREA SERINA (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SERINA
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7497 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2324
Mailing Address - Country:US
Mailing Address - Phone:352-592-5178
Mailing Address - Fax:
Practice Address - Street 1:7497 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34607-2324
Practice Address - Country:US
Practice Address - Phone:352-592-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist