MEDICARE: CENTRAL OKLAHOMA SPEECH AND LANGUAGE SERVICES

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	235500000X	Speech/Language/Hearing Specialist/Technologist	3632	OK

General Provider Information

NPI Number	:	1568865012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OKLAHOMA SPEECH AND LANGUAGE SERVICES

Provider Business Mailing Address
First Line	:	1155 BAILEY CIR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-9746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BAILEY CIR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-9746
Country	:	US
Telephone Number	:	405-323-4448
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	JENNA ENSZ
Credential	:
Telephone Number	:	405-323-4448

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/29/2014

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Directions to “CENTRAL OKLAHOMA SPEECH AND LANGUAGE SERVICES ” Practice Location

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