Provider Demographics
NPI:1225115983
Name:DUPPONG, LAURA JEAN (M ED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:DUPPONG
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5528
Mailing Address - Country:US
Mailing Address - Phone:918-259-5784
Mailing Address - Fax:
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5530
Practice Address - Country:US
Practice Address - Phone:918-259-5784
Practice Address - Fax:918-251-0689
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKY 200062210AMedicaid