Provider Demographics
NPI:1124011135
Name:MCREE-DESHA, MIKI (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MIKI
Middle Name:
Last Name:MCREE-DESHA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1745
Mailing Address - Country:US
Mailing Address - Phone:806-359-7681
Mailing Address - Fax:806-359-7755
Practice Address - Street 1:1300 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1745
Practice Address - Country:US
Practice Address - Phone:806-359-7681
Practice Address - Fax:806-359-7755
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist