=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982444329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA LANDUA M.S. CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2024
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E DANFORTH RD STE 130
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-4485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 397-355-0405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 GOLDEN LN
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73012-4286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-261-8894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235500000X
-----------------------------------------------------
Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
-----------------------------------------------------
License Number | 6491
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------