Provider Demographics
NPI:1962878652
Name:PRESLEY, SHAWN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:SLP-CCC
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 1963
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1963
Mailing Address - Country:US
Mailing Address - Phone:918-457-6713
Mailing Address - Fax:
Practice Address - Street 1:7966 W 790 RD
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-2880
Practice Address - Country:US
Practice Address - Phone:918-478-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist