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Individual

MRS. TARA MICHELLE STEPHENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS CCC

Contact information

Practice address
25888 MAY AVE, BLANCHARD, OK 73010-4811
(405) 485-3650
Mailing address
25888 MAY AVE, BLANCHARD, OK 73010
(405) 485-3650

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2947
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
20023635DA
OK
Enumeration date
03/19/2009
Last updated
11/06/2024
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