Provider Demographics
NPI:1164159620
Name:WILKINS, HALLEY SHANNON
Entity Type:Individual
Prefix:
First Name:HALLEY
Middle Name:SHANNON
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170752 COLE CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055
Mailing Address - Country:US
Mailing Address - Phone:918-637-8365
Mailing Address - Fax:
Practice Address - Street 1:1030 ASH AVE
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529-2636
Practice Address - Country:US
Practice Address - Phone:918-637-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist