Provider Demographics
NPI:1568834091
Name:29TH STREET THERAPY CENTER
Entity type:Organization
Organization Name:29TH STREET THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-568-0019
Mailing Address - Street 1:1211 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-9651
Mailing Address - Country:US
Mailing Address - Phone:405-224-0002
Mailing Address - Fax:405-224-0133
Practice Address - Street 1:1211 S 29TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-9651
Practice Address - Country:US
Practice Address - Phone:405-224-0002
Practice Address - Fax:405-224-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty