Provider Demographics
NPI:1225405848
Name:PLUNKETT, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E B ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3906
Mailing Address - Country:US
Mailing Address - Phone:918-299-4411
Mailing Address - Fax:
Practice Address - Street 1:205 E B ST
Practice Address - Street 2:HIGH SCHOOL - BUILDING 6
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3906
Practice Address - Country:US
Practice Address - Phone:918-299-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist