| NPI | 1790203073 |
|---|---|
| Former Name | CARLY JAMISON CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 6628) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2020-01-27 |