Provider Demographics
NPI:1245571553
Name:BARTLETT, ALLIE M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:M
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 BRADFORD CIR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-5079
Mailing Address - Country:US
Mailing Address - Phone:580-450-6092
Mailing Address - Fax:
Practice Address - Street 1:8801 S OLIE AVE
Practice Address - Street 2:BUILDING 5
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9359
Practice Address - Country:US
Practice Address - Phone:405-212-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14062367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist