MEDICARE: ELDERCOM OF CLEAR LAKE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	92506	TX

General Provider Information

NPI Number	:	1124203518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERCOM OF CLEAR LAKE, INC

Provider Business Mailing Address
First Line	:	3027 MARINA BAY DR
Second Line	:	SUITE 110
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2729
Country	:	US
Telephone Number	:	281-642-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3027 MARINA BAY DR
Second Line	:	SUITE 110
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2729
Country	:	US
Telephone Number	:	281-642-2700
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLGIST
Name	:	TONI TURNER
Credential	:	MCD CCC SLP
Telephone Number	:	281-642-2700

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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