Healthcare Provider Details

I. General information

NPI: 1821088501
Provider Name (Legal Business Name): STATE OF OKLAHOMA BOARD OF REGENTS THE UNIV OF OKLA HEALTH SCIENCE CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STONEWALL AVE JOHN W KEYS SPEECH AND HEARING CENTER
OKLAHOMA CITY OK
73104-1215
US

IV. Provider business mailing address

1200 N STONEWALL AVE JOHN W KEYS SPEECH AND HEARING CENTER
OKLAHOMA CITY OK
73117-1215
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4214
  • Fax: 405-271-3360
Mailing address:
  • Phone: 405-271-4214
  • Fax: 405-271-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENIELLE GREENLEE
Title or Position: ASSOCIATE DEAN FOR FINANCE
Credential: BBA MPH
Phone: 405-271-2288