Individual
STEPHANIE WILLBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 W CHISHOLM DR, KINGFISHER, OK 73750-4348
(405) 375-4194
Mailing address
1201 WALTON TRL, KINGFISHER, OK 73750-4500
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3326
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12097386
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
—
Enumeration date
08/20/2015
Last updated
08/20/2015
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