Provider Demographics
NPI:1194182279
Name:CLARKE, DONYALE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:DONYALE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MA 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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-0753
Mailing Address - Country:US
Mailing Address - Phone:803-384-0522
Mailing Address - Fax:
Practice Address - Street 1:505 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:NESMITH
Practice Address - State:SC
Practice Address - Zip Code:29580-3252
Practice Address - Country:US
Practice Address - Phone:803-384-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist