Individual
MRS. TABETHA NICOLE MATHIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
205 E CIMARRON BLVD, CRESCENT, OK 73028-9296
(405) 795-7110
Mailing address
205 E CIMARRON BLVD, CRESCENT, OK 73028-9296
(405) 795-7110
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3775
OK
Other
Enumeration date
09/11/2012
Last updated
07/11/2013
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