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General NPI Number Information
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NPI Number | 1881862746
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Entity Type | Organization
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Legal Business Name | ACEBO SPEECH AND LANGUAGE SERVICES
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 510 N DOUGLAS ST
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City | JENKS
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State | OK
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Zip | 74037-3801
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Country | US
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Telephone | 918-645-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 510 N DOUGLAS ST
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City | JENKS
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State | OK
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Zip | 74037-3801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER-SPEECH PATHOLOGIST
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Name | MRS. LYNETTE R ACEBO
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Credential | MS CCC-SLP
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Telephone | 918-645-3020
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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 | 2910
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License Number State | OK
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