Healthcare Provider Details

I. General information

NPI: 1912204454
Provider Name (Legal Business Name): OKLAHOMA SPEECH CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 E INDEPENDENCE ST
SHAWNEE OK
74804-4137
US

IV. Provider business mailing address

1318 E INDEPENDENCE ST
SHAWNEE OK
74804-4137
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-1801
  • Fax: 866-347-6279
Mailing address:
  • Phone: 405-275-1801
  • Fax: 866-347-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3606
License Number StateOK

VIII. Authorized Official

Name: KARI M LAXSON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 405-209-2748