Provider Demographics
NPI:1427727882
Name:FREEMAN, MARK WENDELL
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WENDELL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
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 2216
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-9616
Mailing Address - Country:US
Mailing Address - Phone:918-606-2336
Mailing Address - Fax:
Practice Address - Street 1:9045 N 121ST EAST AVE STE 1100
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5352
Practice Address - Country:US
Practice Address - Phone:918-609-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK972237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist