Provider Demographics
NPI:1215395066
Name:CHEEK-GOSNEY, MICHELLE (MS-CCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHEEK-GOSNEY
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GOSNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,-CCC
Mailing Address - Street 1:1221 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 E BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-2110
Practice Address - Country:US
Practice Address - Phone:580-227-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist