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General NPI Number Information
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NPI Number | 1124203518
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Entity Type | Organization
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Legal Business Name | ELDERCOM OF CLEAR LAKE, INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 3027 MARINA BAY DR SUITE 110
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2729
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Country | US
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Telephone | 281-642-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 MARINA BAY DR SUITE 110
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2729
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Country | US
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Telephone | 281-642-2700
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLGIST
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Name | TONI TURNER
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Credential | MCD CCC SLP
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Telephone | 281-642-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 92506
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License Number State | TX
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