Provider Demographics
NPI:1225104185
Name:KING, LINDA MARIAN
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIAN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:MARIAN
Other - Last Name:HAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC - SLP
Mailing Address - Street 1:9007 S. 43RD E. AVE.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-3416
Mailing Address - Country:US
Mailing Address - Phone:918-698-3574
Mailing Address - Fax:
Practice Address - Street 1:7146 S BRADEN AVE
Practice Address - Street 2:# 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6371
Practice Address - Country:US
Practice Address - Phone:918-488-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist