NPI 1538692249

Russell Clark, AUD

Practitioner Audiologist Eagle, ID

Practice location

Address: 3101 E State St STE 2108, Eagle, ID 83616-6232
Phone: (208) 385-3480
Fax: (208) 385-3481

Registered specialties

Audiologist Primary

Speech, Language and Hearing Service Providers Taxonomy 231H00000X Licence AUD-1526 (ID)

Other Audiologist providers in Idaho →

Registry record

NPI: 1538692249
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Apr 2017
Record last updated: 1 Mar 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.