Provider Demographics
NPI:1205039450
Name:STOEVER, SALLY (SLP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STOEVER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:MULLENIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:2221 W DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3628
Mailing Address - Country:US
Mailing Address - Phone:918-615-6492
Mailing Address - Fax:918-615-6493
Practice Address - Street 1:2221 W DETROIT ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3628
Practice Address - Country:US
Practice Address - Phone:918-615-6492
Practice Address - Fax:918-615-6493
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744030AMedicaid
OK100654160CMedicaid