Healthcare Provider Details

I. General information

NPI: 1841825536
Provider Name (Legal Business Name): SPEECH BY MELISSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N SARA RD STE 120
YUKON OK
73099-3682
US

IV. Provider business mailing address

4301 N SARA RD STE 120
YUKON OK
73099-3682
US

V. Phone/Fax

Practice location:
  • Phone: 405-982-2086
  • Fax: 405-900-4062
Mailing address:
  • Phone: 405-328-8781
  • 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: MELISSA KAY LONGHURST
Title or Position: OWNER
Credential: MS CCC-SLP
Phone: 405-328-8781