Provider Demographics
NPI:1396845541
Name:BINGHAM, MELISSA DAWN (MA,, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MA,, CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14483 S 209TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6314
Mailing Address - Country:US
Mailing Address - Phone:918-279-0811
Mailing Address - Fax:918-279-0811
Practice Address - Street 1:5110 S YALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7401
Practice Address - Country:US
Practice Address - Phone:918-497-6554
Practice Address - Fax:918-645-8686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10063870BMedicaid
OK10063870CMedicaid