MEDICARE: DEWEBER AND ASSOCIATES, PLLC

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	3139	OK

General Provider Information

NPI Number	:	1629373451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEWEBER AND ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	2405 NW 39TH
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-601-7080
Fax Number	:	405-601-7081

Provider Business Practice Location Address
First Line	:	2405 NW 39TH
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-601-7080
Fax Number	:	405-601-7081

Authorized Official
Title or Position	:	OWNER
Name	:	DERICK D DEWEBER
Credential	:	MS, CCC-SLP
Telephone Number	:	405-601-7080

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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