Provider Demographics
NPI:1053361741
Name:SPEECH PATHWAYS, PLLC
Entity type:Organization
Organization Name:SPEECH PATHWAYS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-223-1313
Mailing Address - Street 1:1002 STANLEY ST SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4638
Mailing Address - Country:US
Mailing Address - Phone:580-226-5210
Mailing Address - Fax:
Practice Address - Street 1:812 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5708
Practice Address - Country:US
Practice Address - Phone:580-223-1313
Practice Address - Fax:580-223-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK441868611-001OtherBCBS 12 DIGIT #
OK441868611-001OtherBCBS 12 DIGIT #