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General NPI Number Information
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NPI Number | 1013778778
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Entity Type | Organization
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Legal Business Name | MONARCH SPEECH AND LANGUAGE INSTITUTE, LLC
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 16205 S 86TH EAST AVE
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City | BIXBY
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State | OK
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Zip | 74008-3272
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Country | US
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Telephone | 918-840-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 16205 S 86TH EAST AVE
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City | BIXBY
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State | OK
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Zip | 74008-3272
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Country | US
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Telephone | 918-840-0870
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | ELIANA PROVENZANO-LEWIS
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Credential | M.S.,CCC-SLP
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Telephone | 918-840-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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