Provider Demographics
NPI:1891347555
Name:YOUR HOME SPEECH THERAPY
Entity Type:Organization
Organization Name:YOUR HOME SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:918-515-0995
Mailing Address - Street 1:26124 E 90TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-3263
Mailing Address - Country:US
Mailing Address - Phone:918-515-0995
Mailing Address - Fax:
Practice Address - Street 1:5550 S LEWIS AVE # 305
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7118
Practice Address - Country:US
Practice Address - Phone:918-515-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR HOME SPEECH THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty