Provider Demographics
NPI:1104269562
Name:STILLWATER SPEECH-LANGUAGE SERVICES
Entity type:Organization
Organization Name:STILLWATER SPEECH-LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBERTS HINER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:405-377-8255
Mailing Address - Street 1:814 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4225
Mailing Address - Country:US
Mailing Address - Phone:405-377-8255
Mailing Address - Fax:405-377-8255
Practice Address - Street 1:814 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4225
Practice Address - Country:US
Practice Address - Phone:405-377-8255
Practice Address - Fax:405-377-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty