Individual
GINGER ANDRESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. SLP-CCC
Contact information
Practice address
4017 S QUINOA AVE, BROKEN ARROW, OK 74011-1124
(918) 671-8118
Mailing address
4017 S QUINOA AVE, BROKEN ARROW, OK 74011-1124
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2896
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200034880A
—
OK
Enumeration date
05/15/2007
Last updated
04/06/2021
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