Provider Demographics
NPI:1912204454
Name:OKLAHOMA SPEECH CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA SPEECH CONSULTANTS, PLLC
Other - Org Name:LATITUDE LEARNING AND THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:405-209-2748
Mailing Address - Street 1:1318 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4137
Mailing Address - Country:US
Mailing Address - Phone:405-275-1801
Mailing Address - Fax:866-347-6279
Practice Address - Street 1:1318 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4137
Practice Address - Country:US
Practice Address - Phone:405-275-1801
Practice Address - Fax:866-347-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 2251P0200X, 225XP0200X
OK3606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200321560AMedicaid