Healthcare Provider Details

I. General information

NPI: 1831022375
Provider Name (Legal Business Name): COURTNEY LORRAINE VAN ETTEN SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S COLTRANE RD STE A
EDMOND OK
73034-6729
US

IV. Provider business mailing address

501 S COLTRANE RD STE A
EDMOND OK
73034-6729
US

V. Phone/Fax

Practice location:
  • Phone: 580-318-9415
  • Fax: 405-999-4998
Mailing address:
  • Phone: 580-318-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA251
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: