Provider Demographics
NPI:1295716017
Name:MOUNT SAINT CLARE SPEECH AND HEARING CENTER INC
Entity type:Organization
Organization Name:MOUNT SAINT CLARE SPEECH AND HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPEECH PATHOLOGY
Authorized Official - Phone:563-242-4070
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0361
Mailing Address - Country:US
Mailing Address - Phone:563-242-5316
Mailing Address - Fax:563-242-3128
Practice Address - Street 1:562 N BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732
Practice Address - Country:US
Practice Address - Phone:563-242-4070
Practice Address - Fax:563-242-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66526OtherBCBS
IA0665265Medicaid
IL=========201Medicaid
IA166526Medicare Oscar/Certification