Provider Demographics
NPI:1215558614
Name:MASS, MICHAELA SKY (CF-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:SKY
Last Name:MASS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 OLD SAVAGE HWY
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-5038
Mailing Address - Country:US
Mailing Address - Phone:918-315-3675
Mailing Address - Fax:
Practice Address - Street 1:1029 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4849
Practice Address - Country:US
Practice Address - Phone:918-423-2220
Practice Address - Fax:918-423-2620
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program