MEDICARE: CLEAR TALK SPEECH THERAPY LLC

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	235Z00000X	Speech-Language Pathologist	SLP-1643	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184136798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR TALK SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	3231 SPRING CREEK DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-8437
Country	:	US
Telephone Number	:	208-320-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 SPRING CREEK DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-8437
Country	:	US
Telephone Number	:	208-320-5686
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MR. EZEKIEL HANS KELSEY
Credential	:
Telephone Number	:	208-320-5686

Provider Enumeration Date	:	11/04/2017
Last Update Date	:	11/04/2017

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Directions to “CLEAR TALK SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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