Provider Demographics
NPI:1801678610
Name:CLARK, SYLVIA Y (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:Y
Last Name:CLARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PLEASANT HOME RD STE 2K
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0510
Mailing Address - Country:US
Mailing Address - Phone:706-724-6543
Mailing Address - Fax:206-350-9023
Practice Address - Street 1:106 PLEASANT HOME RD STE 2K
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0510
Practice Address - Country:US
Practice Address - Phone:706-724-6543
Practice Address - Fax:206-350-9023
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist