Provider Demographics
NPI:1497868566
Name:COMMUNICATION GAP, LLC
Entity Type:Organization
Organization Name:COMMUNICATION GAP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZABARGER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CCC-SLP
Authorized Official - Phone:405-840-1335
Mailing Address - Street 1:7201 NORTH CLASSEN BLVD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7123
Mailing Address - Country:US
Mailing Address - Phone:405-840-1335
Mailing Address - Fax:405-840-1336
Practice Address - Street 1:7201 NORTH CLASSEN BLVD.
Practice Address - Street 2:SUITE 106
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7123
Practice Address - Country:US
Practice Address - Phone:405-840-1335
Practice Address - Fax:405-840-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100656080BMedicaid
OK100656080BMedicaid