Healthcare Provider Details

I. General information

NPI: 1467180398
Provider Name (Legal Business Name): ALL HEART PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SW 27TH ST
MOORE OK
73160-5521
US

IV. Provider business mailing address

628 SW 27TH ST
MOORE OK
73160-5521
US

V. Phone/Fax

Practice location:
  • Phone: 405-639-9180
  • Fax:
Mailing address:
  • Phone: 405-639-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ELAINE WHITE
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 405-639-9180