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General NPI Number Information
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NPI Number | 1245995059
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Entity Type | Organization
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Legal Business Name | EDMOND SPEECH THERAPY LLC
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Dates
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Enumeration Date | 11/05/2021
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 209 LILAC DR STE 130
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City | EDMOND
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State | OK
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Zip | 73034-7208
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Country | US
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Telephone | 405-295-5753
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Fax | 405-562-7034
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Provider Business Mailing Address
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Address Line | 209 LILAC DR STE 130
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City | EDMOND
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State | OK
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Zip | 73034-7208
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Country | US
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Telephone | 405-295-5753
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Fax | 405-562-7034
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Authorized Official
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Title or Position | MEMBER, SPEECH-LANGUAGE PATHOLOGIST
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Name | CARLEE HARRIS
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Credential | M.A. CCC-SLP
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Telephone | 405-295-5753
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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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