Provider Demographics
NPI:1972013977
Name:CLEARTALK SPEECH AND LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:CLEARTALK SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:COLUMBA PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:503-567-6326
Mailing Address - Street 1:17920 NE 198TH CT
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-8806
Mailing Address - Country:US
Mailing Address - Phone:503-567-6326
Mailing Address - Fax:888-974-0252
Practice Address - Street 1:16703 SE MCGILLIVRAY BLVD STE 170
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4301
Practice Address - Country:US
Practice Address - Phone:360-989-7347
Practice Address - Fax:888-974-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2081962Medicaid