Provider Demographics
NPI:1093007676
Name:LONGHURST, MELISSA KAY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:LONGHURST
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:ALLSBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4301 N SARA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3682
Mailing Address - Country:US
Mailing Address - Phone:405-328-8781
Mailing Address - Fax:
Practice Address - Street 1:4301 N SARA RD STE 120
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3682
Practice Address - Country:US
Practice Address - Phone:405-982-2086
Practice Address - Fax:405-900-4062
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP1770235Z00000X
OK3482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12116391OtherASHA NUMBER