MEDICARE: COURTNEY BRANCH M.S. 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	3023	OK

General Provider Information

NPI Number	:	1942686027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BRANCH M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	15 TYLER LN
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74801-9644
Country	:	US
Telephone Number	:	405-275-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 NATIONAL AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-8518
Country	:	US
Telephone Number	:	405-737-8200
Fax Number	:

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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Directions to “ COURTNEY BRANCH M.S. CCC-SLP” Practice Location

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