Provider Demographics
NPI:1962091769
Name:CLARKE, ASHLEY (MS RDN CDN)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS RDN CDN
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GEBCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RDN CDN
Mailing Address - Street 1:134 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3228
Mailing Address - Country:US
Mailing Address - Phone:315-491-8617
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered