| NPI | 1457671919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY R FULLER Clinic Manager 918-409-0157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OK 3507) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2018-02-01 |