Provider Demographics
NPI:1043241086
Name:DEAL, AMY LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:DEAL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STONEWALL AVE
Mailing Address - Street 2:JOHN W KEYS SPEECH AND HEARING CENTER
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1215
Mailing Address - Country:US
Mailing Address - Phone:405-271-4214
Mailing Address - Fax:405-271-3360
Practice Address - Street 1:1200 N STONEWALL AVE
Practice Address - Street 2:JOHN W KEYS SPEECH AND HEARING CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1215
Practice Address - Country:US
Practice Address - Phone:405-271-4214
Practice Address - Fax:405-271-3360
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100674100AMedicaid
OK736017987OtherTAX ID