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NPI Code Detail

MEDICARE: COURTNEY LORRAINE VAN ETTEN SLPA

MEDICARE: COURTNEY LORRAINE VAN ETTEN SLPA
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
12355S0801XSpeech-Language AssistantSLPA251OK

General Provider Information

NPI Number : 1831022375
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY LORRAINE VAN ETTEN SLPA
Provider Business Mailing Address
First Line : 501 S COLTRANE RD STE A
Second Line :
City : EDMOND
State : OK
Zip : 73034-6729
Country : US
Telephone Number : 580-318-9415
Fax Number :
Provider Business Practice Location Address
First Line : 501 S COLTRANE RD STE A
Second Line :
City : EDMOND
State : OK
Zip : 73034-6729
Country : US
Telephone Number : 580-318-9415
Fax Number : 405-999-4998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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Directions to “ COURTNEY LORRAINE VAN ETTEN SLPA” Practice Location

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