Provider Demographics
NPI:1235377284
Name:WINGO, BETSY LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:LYNN
Last Name:WINGO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:BETSY
Other - Middle Name:LYNN
Other - Last Name:BRAWNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:301 S. BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-285-6765
Mailing Address - Fax:405-285-5403
Practice Address - Street 1:301 S. BOULEVARD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-285-6765
Practice Address - Fax:405-285-5403
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1650235Z00000X
OK3447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist