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Individual

LAURA TIDENBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS CCC SLP

Contact information

Practice address
801 FAIRLANE DR, MIDWEST CITY, OK 73110-1629
(918) 839-9852
Mailing address
801 FAIRLANE DR, MIDWEST CITY, OK 73110-1629

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4607
OK

Other

Enumeration date
08/09/2016
Last updated
08/09/2016
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