Provider Demographics
NPI:1366118796
Name:STORK, ABBIE MARIE (MS)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:MARIE
Last Name:STORK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:MARIE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2317 MORGANDEE LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2927
Mailing Address - Country:US
Mailing Address - Phone:580-334-4428
Mailing Address - Fax:
Practice Address - Street 1:118 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-8321
Practice Address - Country:US
Practice Address - Phone:580-661-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA