Provider Demographics
NPI:1205157211
Name:CLARK-ALLEN, VONETTA L (CCC/SLP)
Entity type:Individual
Prefix:
First Name:VONETTA
Middle Name:L
Last Name:CLARK-ALLEN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18502 GREEN LAND WAY STE D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7967
Mailing Address - Country:US
Mailing Address - Phone:281-717-4308
Mailing Address - Fax:
Practice Address - Street 1:18502 GREEN LAND WAY STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7967
Practice Address - Country:US
Practice Address - Phone:281-717-4308
Practice Address - Fax:877-886-0898
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist