=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235717711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRISKELL SPEECH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2021
-----------------------------------------------------
Last Update Date | 03/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 SE 2ND ST
-----------------------------------------------------
City | BLANCHARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73010-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-779-3270
-----------------------------------------------------
Fax | 405-293-3500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 SE 2ND ST
-----------------------------------------------------
City | BLANCHARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73010-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-779-3270
-----------------------------------------------------
Fax | 405-293-3500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | ANDREA M WOOD
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 405-779-3270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------