Provider Demographics
NPI:1033520283
Name:PLETKA, FARINAM MOEENI (MS)
Entity Type:Individual
Prefix:
First Name:FARINAM
Middle Name:MOEENI
Last Name:PLETKA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N SHARTEL AVE
Mailing Address - Street 2:#200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2400
Mailing Address - Country:US
Mailing Address - Phone:403-355-3239
Mailing Address - Fax:
Practice Address - Street 1:4100 PERIMETER CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2326
Practice Address - Country:US
Practice Address - Phone:403-355-3239
Practice Address - Fax:405-212-4270
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist