Provider Demographics
NPI:1750003943
Name:CLARK, NATALIE LAUREN
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LAUREN
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NORTH STAR RD
Mailing Address - Street 2:APT 3203
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208
Mailing Address - Country:US
Mailing Address - Phone:361-550-9234
Mailing Address - Fax:
Practice Address - Street 1:1501 NORTHSTAR RD
Practice Address - Street 2:APT #3203
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:361-550-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist