Provider Demographics
NPI:1871819433
Name:AGS SPEECH LANGUAGE PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:AGS SPEECH LANGUAGE PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC/SLP
Authorized Official - Phone:918-606-0944
Mailing Address - Street 1:7501 S TRENTON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7340
Mailing Address - Country:US
Mailing Address - Phone:918-606-0944
Mailing Address - Fax:918-493-1162
Practice Address - Street 1:7501 S TRENTON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7340
Practice Address - Country:US
Practice Address - Phone:918-606-0944
Practice Address - Fax:918-493-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1013173616Medicaid