| NPI | 1013778778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIANA PROVENZANO-LEWIS Speech Language Pathologist 918-840-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |