Provider Demographics
NPI:1063195048
Name:CLARKE, MARY E (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CLARKE
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 1:541 S RED HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6483
Mailing Address - Country:US
Mailing Address - Phone:302-674-3350
Mailing Address - Fax:
Practice Address - Street 1:541 S RED HAVEN LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6483
Practice Address - Country:US
Practice Address - Phone:302-674-3350
Practice Address - Fax:928-752-3350
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0012260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist