Provider Demographics
NPI:1841407384
Name:COMMUNICATION & LEARNING CLINIC, LLC
Entity Type:Organization
Organization Name:COMMUNICATION & LEARNING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-482-2239
Mailing Address - Street 1:6039 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4410
Mailing Address - Country:US
Mailing Address - Phone:260-482-2239
Mailing Address - Fax:877-459-3403
Practice Address - Street 1:6039 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4410
Practice Address - Country:US
Practice Address - Phone:260-482-2239
Practice Address - Fax:877-459-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200725260OtherFIRST STEPS PROVIDER