Provider Demographics
NPI:1013778778
Name:MONARCH SPEECH AND LANGUAGE INSTITUTE, LLC
Entity type:Organization
Organization Name:MONARCH SPEECH AND LANGUAGE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENZANO-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:918-840-0870
Mailing Address - Street 1:16205 S 86TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3272
Mailing Address - Country:US
Mailing Address - Phone:918-840-0870
Mailing Address - Fax:
Practice Address - Street 1:16205 S 86TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3272
Practice Address - Country:US
Practice Address - Phone:918-840-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty