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General NPI Number Information
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NPI Number | 1255806576
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Entity Type | Organization
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Legal Business Name | CREEKSIDE SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 10/13/2018
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Provider Practice Location Address
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Address Line | 8 S CREEK SIDE DR
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City | EDMOND
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State | OK
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Zip | 73012-4234
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Country | US
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Telephone | 405-757-2345
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Fax | 405-359-3600
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Provider Business Mailing Address
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Address Line | 8 S CREEK SIDE DR
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City | EDMOND
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State | OK
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Zip | 73012-4234
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Country | US
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Telephone | 405-757-2345
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Fax | 405-359-3600
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | EMILY BARSTOW
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Credential | CCC-SLP
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Telephone | 405-757-2345
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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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