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General NPI Number Information
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NPI Number | 1629306477
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 8524 S WESTERN AVE SUITE - 112
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9246
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Country | US
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Telephone | 405-640-7045
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Fax | 405-702-9397
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Provider Business Mailing Address
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Address Line | 8524 S WESTERN AVE SUITE - 112
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9246
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Country | US
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Telephone | 405-640-7045
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Fax | 405-702-9397
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
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Name | BRENDA DAVIS
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Credential | M.ED., CCC-SLP
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Telephone | 405-640-7045
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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 | 2755
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License Number State | OK
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