Eliana Provenzano-Lewis

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5512 Issued in OK

Practice address

16205 S 86TH East Ave
Bixby, OK 74008-3272

Phone

(918) 840-0870

NPI assigned

Jan 28, 2021

Last updated

Jan 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Monarch Speech and Language Institute, LLC

  • Speech-Language Pathologist
  • Bixby, OK
  • NPI 1013778778
  NPD Authorized official
• Collaborative Therapy Services Inc

  dba Tulsa Sunshine Center

  • Multi-Specialty Clinic/Center
  • Broken Arrow, OK
  • NPI 1932344835
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1821689373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16205 S 86TH EAST AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083272",
            "telephone_number": "918-840-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16205 S 86TH EAST AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083272",
            "telephone_number": "918-840-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO-LEWIS",
        "first_name": "ELIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "5512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Pediatric and Adolescent Care of Bixby
• Sean Michael Price, PHARM.D
• Prophylaxis Healthcare LLC (Axis Behavioral Health)
• Prophylaxis Healthcare LLC (Axis HealthCare)
• Prophylaxis Primary Care and Behavioral Healthcare Services Inc
• Rapid Care, Inc.
• Jeff Ravenscroft
• Terry Justin Reavis, DDS
• Laura Reibenstein, PHARMD
• Amelia Danielle Rice

• Speech-Language Pathologist in Bixby, OK
• Providers in Bixby, OK by specialty
• Speech-Language Pathologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.