Individual
MRS. NICKI JO THEODORIDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.,CCC-SLP
Contact information
Practice address
715 GLENRIDGE DR, EDMOND, OK 73013-1824
(816) 753-5459
(816) 753-5119
Mailing address
715 GLENRIDGE DR, EDMOND, OK 73013-1824
(816) 753-5459
(816) 753-5119
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2016009648
MO
235Z00000X
Speech-Language Pathologist
3903
KS
235Z00000X
Speech-Language Pathologist
Primary
996
OK
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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