Provider Demographics
NPI:1972833408
Name:CLARK, RACHEL L (AUD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GERMANTOWN PIKE
Mailing Address - Street 2:UNIT F1
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2480
Mailing Address - Country:US
Mailing Address - Phone:484-231-1340
Mailing Address - Fax:484-231-1352
Practice Address - Street 1:1000 GERMANTOWN PIKE
Practice Address - Street 2:UNIT F1
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2480
Practice Address - Country:US
Practice Address - Phone:484-231-1340
Practice Address - Fax:484-231-1352
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006151237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter