Provider Demographics
NPI:1063938959
Name:WILKINSON, LORI ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BECKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3102 S SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4103
Mailing Address - Country:US
Mailing Address - Phone:918-884-8165
Mailing Address - Fax:
Practice Address - Street 1:4833 S SHERIDAN RD STE 412
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5718
Practice Address - Country:US
Practice Address - Phone:918-884-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist