| NPI | 1124334958 |
|---|---|
| Former Name | GENNA EVE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: AZ SLP6948) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: AZ TSLP6948) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2019-11-13 |