Provider Demographics
NPI:1326870536
Name:KRUEGER PFANNSCHMIDT, DEANA (SLPD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:KRUEGER PFANNSCHMIDT
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720387
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4285
Mailing Address - Country:US
Mailing Address - Phone:405-664-4184
Mailing Address - Fax:
Practice Address - Street 1:3917 NW STERLING ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1241
Practice Address - Country:US
Practice Address - Phone:405-664-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN193104235Z00000X
OK5470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist