Clark, Shannon
Clark, Shannon is an individual health care provider with primary practice located at 1208 Ih 35 N Ste Q , Round Rock TX 78681-4204. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Assistant, which is considered as her primary health care specialty. Clark, Shannon can be contacted via phone (512) 310-7665.Contact Information
Primary practice address
1208 Ih 35 N Ste Q
Round Rock TX 78681-4204
Phone: (512) 310-7665
Fax: (512) 310-9228
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Assistant | 2355S0801X | 35304 | Texas |
Profile Details
| NPI number | 1114255734 |
|---|---|
| LBN Legal business name | Clark, Shannon |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 19th, 2009 |
| Last updated | Nov 19th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114255734 | NPPES |
| Texas | MEDICAID | 0944746-02 | |
| Texas | Other | 0031DG | |
| Texas | Other | 74-2745294 |
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