Individual
MRS. SHANNON KAY ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
399351 W 2750 RD, RAMONA, OK 74061-3349
(918) 535-2225
Mailing address
399351 W 2750 RD, RAMONA, OK 74061-3349
(918) 535-2225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
136
OK
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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