Provider Demographics
NPI:1184636961
Name:MARFECHUK, RONDA BLAKEMORE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:BLAKEMORE
Last Name:MARFECHUK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5523
Mailing Address - Country:US
Mailing Address - Phone:918-622-3724
Mailing Address - Fax:
Practice Address - Street 1:3724 S FULTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5523
Practice Address - Country:US
Practice Address - Phone:918-622-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist