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Individual

RAEGEN S GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S., CCC-SLP

Contact information

Practice address
2790 OLD HIGHWAY 20 E, PRYOR, OK 74361-2954
(918) 864-1099
Mailing address
2790 OLD HIGHWAY 20 E, PRYOR, OK 74361-2954
(918) 864-1099

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5731
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14296746
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
01
5731
OKLAHOMA STATE LICENSE
OK
Enumeration date
04/15/2022
Last updated
07/20/2023
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