Provider Demographics
NPI:1174647143
Name:STECK, CYNTHIA D (SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:STECK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9523 E 109TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7187
Mailing Address - Country:US
Mailing Address - Phone:918-970-4407
Mailing Address - Fax:
Practice Address - Street 1:9523 E 109TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7187
Practice Address - Country:US
Practice Address - Phone:918-970-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3630OtherOKLAHOMA BORAD OF EXAMINERS FOR SPEECH PATHOLOGY AND AUDIOLOGY