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General NPI Number Information
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NPI Number | 1053361741
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Entity Type | Organization
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Legal Business Name | SPEECH PATHWAYS, PLLC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 812 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-5708
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Country | US
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Telephone | 580-223-1313
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Fax | 580-223-1629
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Provider Business Mailing Address
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Address Line | 1002 STANLEY ST SW
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City | ARDMORE
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State | OK
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Zip | 73401-4638
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Country | US
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Telephone | 580-226-5210
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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 | JULIE OWEN SHELTON
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Credential | PHD
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Telephone | 580-223-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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