Individual
MRS. ELIZABETH ANN WANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED CCC-SLP
Contact information
Practice address
35040 MIDWAY RD, POTEAU, OK 74953-7464
(918) 658-8481
Mailing address
35040 MIDWAY RD, POTEAU, OK 74953-7464
(918) 658-8481
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2007
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007
OKLAHOMA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY
OK
Enumeration date
05/22/2015
Last updated
05/22/2015
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