Provider Demographics
NPI:1760846976
Name:ABOVE & BEYOND SPEECH THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:ABOVE & BEYOND SPEECH THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ-HIGGINBOTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:918-201-7015
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74477-0232
Mailing Address - Country:US
Mailing Address - Phone:918-201-7015
Mailing Address - Fax:
Practice Address - Street 1:215 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4703
Practice Address - Country:US
Practice Address - Phone:918-201-7015
Practice Address - Fax:918-485-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty