Provider Demographics
NPI:1164658092
Name:CENTER FOR SPEECH & LANGUAGE DEVELOPMENT, PLLC
Entity Type:Organization
Organization Name:CENTER FOR SPEECH & LANGUAGE DEVELOPMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC-SLP
Authorized Official - Phone:405-974-1193
Mailing Address - Street 1:420 S. MUSTANG RD. STE B
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-974-1193
Mailing Address - Fax:
Practice Address - Street 1:420 S MUSTANG RD STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7316
Practice Address - Country:US
Practice Address - Phone:405-974-1193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty