Basic Information
Provider Information
NPI: 1801535711
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRUJILLO
FirstName: CLAUDIA
MiddleName: VERONICA
NamePrefix: MISS
NameSuffix:  
Credential: CF-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 NW 192ND ST APT 2306
Address2:  
City: EDMOND
State: OK
PostalCode: 730129142
CountryCode: US
TelephoneNumber: 5806063137
FaxNumber:  
Practice Location
Address1: 309 SW 59TH ST STE 305
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731098324
CountryCode: US
TelephoneNumber: 4053553239
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2022
LastUpdateDate: 05/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XCF448OKY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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