Provider Demographics
NPI:1326160524
Name:PROFESSIONAL HEARING HEALTHCARE PC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAKIEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRECKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:918-224-5400
Mailing Address - Street 1:9 N WATER ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2819
Mailing Address - Country:US
Mailing Address - Phone:918-224-5400
Mailing Address - Fax:918-512-6443
Practice Address - Street 1:9 N WATER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2819
Practice Address - Country:US
Practice Address - Phone:918-224-5400
Practice Address - Fax:918-512-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK307231H00000X
OK124231H00000X
OK2642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200023540BMedicaid
OK=========OtherTRICARE HUMANA GROUP