Provider Demographics
NPI:1114623998
Name:LOONEY, AUTUM (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUTUM
Middle Name:
Last Name:LOONEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AUTUM
Other - Middle Name:
Other - Last Name:WHITEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18550 144TH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73051-6803
Mailing Address - Country:US
Mailing Address - Phone:405-609-4618
Mailing Address - Fax:405-310-0679
Practice Address - Street 1:310 W WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4230
Practice Address - Country:US
Practice Address - Phone:405-609-4618
Practice Address - Fax:405-310-0679
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4426OtherSTATE LICENSE