Provider Demographics
NPI:1568865012
Name:CENTRAL OKLAHOMA SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-323-4448
Mailing Address - Street 1:1155 BAILEY CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-9746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 BAILEY CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-9746
Practice Address - Country:US
Practice Address - Phone:405-323-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3632235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty