Provider Demographics
NPI:1174297519
Name:MABERRY, MARGO ANN (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:ANN
Last Name:MABERRY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 PRAIRIE ROSE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5355
Mailing Address - Country:US
Mailing Address - Phone:405-437-7211
Mailing Address - Fax:
Practice Address - Street 1:10404 VINEYARD BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3705
Practice Address - Country:US
Practice Address - Phone:405-437-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist