Individual
ELIANA PROVENZANO-LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16205 S 86TH EAST AVE, BIXBY, OK 74008-3272
(918) 840-0870
Mailing address
16205 S 86TH EAST AVE, BIXBY, OK 74008-3272
(918) 840-0870
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5512
OK
Other
Enumeration date
01/28/2021
Last updated
01/22/2024
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