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General NPI Number Information
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NPI Number | 1376434134
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Entity Type | Organization
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Legal Business Name | CLE CREATIONS
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 463 S 194TH LN
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City | BUCKEYE
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State | AZ
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Zip | 85326-6007
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Country | US
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Telephone | 480-487-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 463 S 194TH LN
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City | BUCKEYE
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State | AZ
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Zip | 85326-6007
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Country | US
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Telephone | 480-487-6616
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK GONCHAR
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Credential |
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Telephone | 480-487-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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