Individual
MRS. REBECCA POVLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4116 N OAK AVE, BROKEN ARROW, OK 74012-0751
(816) 805-7566
Mailing address
4116 N OAK AVE, BROKEN ARROW, OK 74012-0751
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3686
OK
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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