Provider Demographics
NPI:1417530932
Name:HERRERA, DENISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10545 TUMILTY TER
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2111
Mailing Address - Country:US
Mailing Address - Phone:405-413-4204
Mailing Address - Fax:
Practice Address - Street 1:5701 SE 74TH ST STE G-H
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1106
Practice Address - Country:US
Practice Address - Phone:405-413-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist