MEDICARE: COMMUNICATION GAP, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497868566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNICATION GAP, LLC

Provider Business Mailing Address
First Line	:	7201 NORTH CLASSEN BLVD.
Second Line	:	SUITE 106
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7123
Country	:	US
Telephone Number	:	405-840-1335
Fax Number	:	405-840-1336

Provider Business Practice Location Address
First Line	:	7201 NORTH CLASSEN BLVD.
Second Line	:	SUITE 106
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7123
Country	:	US
Telephone Number	:	405-840-1335
Fax Number	:	405-840-1336

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. LISA SHULTZABARGER
Credential	:	M. ED., CCC-SLP
Telephone Number	:	405-840-1335

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/23/2009

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Directions to “COMMUNICATION GAP, LLC ” Practice Location

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