Provider Demographics
NPI:1083147037
Name:DURBIN, CAROLYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:DURBIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 EASTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8941
Mailing Address - Country:US
Mailing Address - Phone:405-476-4044
Mailing Address - Fax:
Practice Address - Street 1:2316 EASTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8941
Practice Address - Country:US
Practice Address - Phone:405-476-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14156741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK14156741OtherASHA CERTIFICATION