Provider Demographics
NPI:1366032625
Name:WELLS, SUZANNE K
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:KRAPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:611 ASH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-9592
Mailing Address - Country:US
Mailing Address - Phone:405-872-3472
Mailing Address - Fax:
Practice Address - Street 1:611 ASH ST
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-9592
Practice Address - Country:US
Practice Address - Phone:405-872-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist