Provider Demographics
NPI:1700994878
Name:OKLAHOMA STATE UNIVERSITY
Entity Type:Organization
Organization Name:OKLAHOMA STATE UNIVERSITY
Other - Org Name:OSU SPEECH-LANGUAGE-HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEFFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-744-8939
Mailing Address - Street 1:042 MURRAY
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-5062
Mailing Address - Country:US
Mailing Address - Phone:405-744-6021
Mailing Address - Fax:405-744-8070
Practice Address - Street 1:042 MURRAY
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078
Practice Address - Country:US
Practice Address - Phone:405-744-6021
Practice Address - Fax:405-744-8070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100757330BMedicaid