MEDICARE: MRS. JAN DODSON WALKER CCC/SLP

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	386	OK
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1669605176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAN DODSON WALKER CCC/SLP

Provider Business Mailing Address
First Line	:	6006 S ATLANTA PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7521
Country	:	US
Telephone Number	:	918-697-7318
Fax Number	:

Provider Business Practice Location Address
First Line	:	6006 S ATLANTA PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7521
Country	:	US
Telephone Number	:	918-697-7318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	08/31/2009

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