=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033742085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISHA KHAN CF-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2020
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 N BROADWAY ST
-----------------------------------------------------
City | TISHOMINGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73460-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-371-2548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 732
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73439-0732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-695-6984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | CF738
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP6521
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------