Provider Demographics
NPI:1225410202
Name:MCGREGOR, DANIELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:EVA
Other - Last Name:KLEVGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1137 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-5127
Mailing Address - Country:US
Mailing Address - Phone:405-669-0908
Mailing Address - Fax:
Practice Address - Street 1:704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4115
Practice Address - Country:US
Practice Address - Phone:405-669-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200591490AMedicaid