Healthcare Provider Details

I. General information

NPI: 1730841024
Provider Name (Legal Business Name): LELAINE VELAZQUEZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 S NEW HAVEN AVE
TULSA OK
74114-6131
US

IV. Provider business mailing address

2552 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

V. Phone/Fax

Practice location:
  • Phone: 918-746-6800
  • Fax:
Mailing address:
  • Phone: 918-893-3735
  • Fax: 918-893-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number981
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: