Provider Demographics
NPI:1366034068
Name:BINGHOM, DESTINEY TAYLOR (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:DESTINEY
Middle Name:TAYLOR
Last Name:BINGHOM
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13804 N 2220 RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-6109
Mailing Address - Country:US
Mailing Address - Phone:580-682-9365
Mailing Address - Fax:
Practice Address - Street 1:13804 N 2220 RD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-6109
Practice Address - Country:US
Practice Address - Phone:580-682-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1492355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant