Provider Demographics
NPI:1891968780
Name:OSU-TULSA SPEECH-LANGUAGE-HEARING CLINIC
Entity Type:Organization
Organization Name:OSU-TULSA SPEECH-LANGUAGE-HEARING CLINIC
Other - Org Name:OKLAHOMA STATE UNIVERSITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:918-594-8573
Mailing Address - Street 1:110 HANNER HALL
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-5060
Mailing Address - Country:US
Mailing Address - Phone:405-744-6021
Mailing Address - Fax:405-744-8070
Practice Address - Street 1:700 N GREENWOOD AVE
Practice Address - Street 2:MAIN HALL 1107
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-0702
Practice Address - Country:US
Practice Address - Phone:918-594-8573
Practice Address - Fax:918-594-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty