1396845541 NPI number — MRS. MELISSA DAWN BINGHAM M.A,, CCC-SLP

Table of content: MRS. MELISSA DAWN BINGHAM M.A,, CCC-SLP (NPI 1396845541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396845541 NPI number — MRS. MELISSA DAWN BINGHAM M.A,, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINGHAM
Provider First Name:
MELISSA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A,, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396845541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14483 S 209TH EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COWETA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74429-6314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-279-0811
Provider Business Mailing Address Fax Number:
918-279-0811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5110 S YALE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-497-6554
Provider Business Practice Location Address Fax Number:
918-645-8686
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2449 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10063870B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10063870C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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