MEDICARE: JUDY D DENNIS M.S., C.C.C./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	104	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002518602999	OTHER	OK	BC/BS

General Provider Information

NPI Number	:	1669476180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY D DENNIS M.S., C.C.C./SLP

Provider Business Mailing Address
First Line	:	3424 HEMLOCK LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5602
Country	:	US
Telephone Number	:	405-755-3893
Fax Number	:	405-755-3950

Provider Business Practice Location Address
First Line	:	3424 HEMLOCK LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5602
Country	:	US
Telephone Number	:	405-755-3893
Fax Number	:	405-755-3950

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/09/2007

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Directions to “ JUDY D DENNIS M.S., C.C.C./SLP” Practice Location

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