Doctor Name: | TARA DEANN WILKS |
NPI Number: | 1205096211 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 3119 |
Business Practice Address: | 1200 E Pecan St Altus, OK - 735216141 |
Business Phone Number: | 5804777226 |
Business Fax Number: | 5804777206 |
Mailing Address: | 2000 E Tamarack Rd, Apt 205 ALTUS |
State: | OK |
Postal Code: | 735219766 |
Phone Number: | 5804777226 |
Fax Number: | 5804777206 |
NPI Enumeration Date: | 06/12/2008 |
NPI Last Update Date: | 06/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3119 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |