Provider Demographics
NPI:1851755235
Name:CHATTERBOX SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:CHATTERBOX SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WESTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:918-694-0626
Mailing Address - Street 1:6301 S DATE AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-4148
Mailing Address - Country:US
Mailing Address - Phone:918-694-0626
Mailing Address - Fax:918-665-1830
Practice Address - Street 1:3202 S MEMORIAL DR
Practice Address - Street 2:STE 2
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1323
Practice Address - Country:US
Practice Address - Phone:918-694-0626
Practice Address - Fax:918-665-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4207235Z00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200533350BMedicaid