MEDICARE: COMMUNICATION STATION THERAPY SERVICES, PLLC

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	4193	OK

General Provider Information

NPI Number	:	1548790256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNICATION STATION THERAPY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	18244 E 49TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10820 E 45TH ST STE 306
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3808
Country	:	US
Telephone Number	:	918-248-8102
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KALEEA N VINCENT
Credential	:	M.S. CCC-SLP
Telephone Number	:	405-334-6024

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	02/13/2020

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