1588380737 NPI number — FULL CIRCLE COMMUNICATION LLC SPEECH LANGUAGE PATHOLOGY SERVICES

Table of content: (NPI 1588380737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588380737 NPI number — FULL CIRCLE COMMUNICATION LLC SPEECH LANGUAGE PATHOLOGY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULL CIRCLE COMMUNICATION LLC SPEECH LANGUAGE PATHOLOGY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1588380737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5933 REGIS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73034-8010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-550-5691
Provider Business Mailing Address Fax Number:
405-906-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5933 REGIS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73034-8010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-550-5691
Provider Business Practice Location Address Fax Number:
405-906-3690
Provider Enumeration Date:
10/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PANKALLA
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
405-550-5691

Provider Taxonomy Codes

  • Taxonomy code: 235500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200214470A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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