Provider Demographics
NPI:1285751123
Name:BECKER, SANDRA KAY (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BECKER
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6211
Mailing Address - Country:US
Mailing Address - Phone:918-456-0850
Mailing Address - Fax:
Practice Address - Street 1:117 CAROL ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-6211
Practice Address - Country:US
Practice Address - Phone:918-456-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist