Provider Demographics
NPI:1083920433
Name:MERCIEZ, DEANN G (MS)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:G
Last Name:MERCIEZ
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 1:202 E 2ND AVE
Mailing Address - Street 2:106
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3132
Mailing Address - Country:US
Mailing Address - Phone:918-609-8784
Mailing Address - Fax:918-517-3041
Practice Address - Street 1:202 E 2ND AVE
Practice Address - Street 2:106
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3132
Practice Address - Country:US
Practice Address - Phone:918-609-8784
Practice Address - Fax:918-517-3041
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200299110AOtherCAQH - 12151600