Healthcare Provider Details

I. General information

NPI: 1811759277
Provider Name (Legal Business Name): LAUREN THORSTENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 S GARNETT RD
BROKEN ARROW OK
74011-1118
US

IV. Provider business mailing address

11207 S 94TH EAST AVE
BIXBY OK
74008-1777
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-7316
  • Fax:
Mailing address:
  • Phone: 918-625-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF958
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: