MEDICARE: CLEAR COMMUNICATION 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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1801471701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR COMMUNICATION THERAPY, LLC

Provider Business Mailing Address
First Line	:	12877 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	12877 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOROTHY TRAIN
Credential	:	MCD, CCC-SLP
Telephone Number	:	904-755-1418

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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