Provider Demographics
NPI:1437593480
Name:BURROWS, CLYDEENA GAYE (MS-CCC)
Entity Type:Individual
Prefix:
First Name:CLYDEENA
Middle Name:GAYE
Last Name:BURROWS
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-6337
Mailing Address - Country:US
Mailing Address - Phone:918-916-1904
Mailing Address - Fax:
Practice Address - Street 1:16 W SENECA AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6337
Practice Address - Country:US
Practice Address - Phone:918-916-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist