Organization Name: | 29TH STREET THERAPY |
NPI Number: | 1578957684 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIELLE EVA KLEVGARD (SPEECH-LANGUAGE PATHOLOGIST) |
Mailing Address: | 1211 S 29th St Chickasha |
State: | OK US |
Postal Code: | 730189651 |
Phone Number: | 4052240002 |
Fax Number: | 4052240133 |
NPI Enumeration Date: | 03/26/2015 |
NPI Last Update Date: | 03/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |