Provider Demographics
NPI:1750620381
Name:CLARK, DANA LYNN (SLPA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 SANDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-5102
Mailing Address - Country:US
Mailing Address - Phone:360-642-0512
Mailing Address - Fax:
Practice Address - Street 1:9303 SANDRIDGE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-5102
Practice Address - Country:US
Practice Address - Phone:360-642-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 601985052355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant