MEDICARE: COMMUNICATION & LEARNING CLINIC, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200725260	OTHER	IN	FIRST STEPS PROVIDER

General Provider Information

NPI Number	:	1841407384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNICATION & LEARNING CLINIC, LLC

Provider Business Mailing Address
First Line	:	6039 STONEY CREEK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4410
Country	:	US
Telephone Number	:	260-482-2239
Fax Number	:	877-459-3403

Provider Business Practice Location Address
First Line	:	6039 STONEY CREEK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4410
Country	:	US
Telephone Number	:	260-482-2239
Fax Number	:	877-459-3403

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA J GERARD
Credential	:
Telephone Number	:	260-482-2239

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/21/2009

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