Provider Demographics
NPI:1225421456
Name:WILLYARD, TRICIA (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:WILLYARD
Suffix:
Gender:F
Credentials:MED 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:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:OK
Mailing Address - Zip Code:74349-0720
Mailing Address - Country:US
Mailing Address - Phone:918-782-5091
Mailing Address - Fax:918-782-9018
Practice Address - Street 1:404 NORTH BOSTON
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:OK
Practice Address - Zip Code:74349
Practice Address - Country:US
Practice Address - Phone:918-782-5091
Practice Address - Fax:918-782-9018
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist