Individual
TARA DEANN WILKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 477-7226
(580) 477-7206
Mailing address
2000 E TAMARACK RD, APT 205, ALTUS, OK 73521-9766
(580) 477-7226
(580) 477-7206
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3119
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201092470A
—
OK
Enumeration date
06/12/2008
Last updated
11/21/2023
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