Provider Demographics
NPI:1386191096
Name:CLEAR TALK MASTERY INC
Entity Type:Organization
Organization Name:CLEAR TALK MASTERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:BL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-818-4579
Mailing Address - Street 1:PO BOX 18381
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1381
Mailing Address - Country:US
Mailing Address - Phone:303-818-4579
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST STE 220-D
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:303-818-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01131420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty