Provider Demographics
NPI:1356552103
Name:VENARD, BARBARA (MEDCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:VENARD
Suffix:
Gender:F
Credentials:MEDCCCSLP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:SANDERSON-VENARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDCCCSLP
Mailing Address - Street 1:1245 WHIPPOORWILL VIS
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7029
Mailing Address - Country:US
Mailing Address - Phone:405-769-1034
Mailing Address - Fax:
Practice Address - Street 1:1245 WHIPPOORWILL VIS
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7029
Practice Address - Country:US
Practice Address - Phone:405-769-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731518750001OtherBLUECROSS & BLUE SHIELD