Provider Demographics
NPI:1750545059
Name:CLARK, LYN MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:LYN
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:M
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1023
Mailing Address - Country:US
Mailing Address - Phone:512-454-0392
Mailing Address - Fax:512-454-1233
Practice Address - Street 1:3705 MEDICAL PKWY STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1023
Practice Address - Country:US
Practice Address - Phone:512-454-0392
Practice Address - Fax:512-454-1233
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50824231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L9804Medicare PIN