Provider Demographics
NPI:1609022367
Name:SPEECH LINK
Entity Type:Organization
Organization Name:SPEECH LINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANDERSON-VENARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP/L
Authorized Official - Phone:405-613-7036
Mailing Address - Street 1:1245 WHIPPOORWILL VIS
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7029
Mailing Address - Country:US
Mailing Address - Phone:405-613-7036
Mailing Address - Fax:
Practice Address - Street 1:1245 WHIPPOORWILL VIS
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7029
Practice Address - Country:US
Practice Address - Phone:405-613-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKINDIVIDUAL - 787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty