MEDICARE: DEANA KRUEGER PFANNSCHMIDT SLP.D, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	193104	MN
2	235Z00000X	Speech-Language Pathologist	5470	OK

General Provider Information

NPI Number	:	1326870536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA KRUEGER PFANNSCHMIDT SLP.D, CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 720387
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-4285
Country	:	US
Telephone Number	:	405-664-4184
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 NW STERLING ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-1241
Country	:	US
Telephone Number	:	405-664-4184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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