Provider Demographics
NPI:1467690784
Name:GREENHAW, AMY JO (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:GREENHAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 E 110TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7257
Mailing Address - Country:US
Mailing Address - Phone:918-298-3757
Mailing Address - Fax:
Practice Address - Street 1:4404 W LOUISVILLE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8870
Practice Address - Country:US
Practice Address - Phone:918-809-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist