Doctor Name: | JARRED CURTIS LUESADA |
NPI Number: | 1891961439 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS-CCCSLP |
License Number: | 3197 |
Business Practice Address: | 5429 Quail Ridge Rd Blanchard, OK - 730103480 |
Business Phone Number: | 4059905262 |
Business Fax Number: | 4053873056 |
Mailing Address: | 5429 Quail Ridge Rd, BLANCHARD |
State: | OK |
Postal Code: | 730103480 |
Phone Number: | 4059905262 |
Fax Number: | 4053873056 |
NPI Enumeration Date: | 05/04/2008 |
NPI Last Update Date: | 02/17/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3197 |
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 |