Provider Demographics
NPI:1467700575
Name:MESSICK, CAROLYN MERETHA (MS, CCC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MERETHA
Last Name:MESSICK
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 1:4600 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7031
Mailing Address - Country:US
Mailing Address - Phone:405-424-1515
Mailing Address - Fax:
Practice Address - Street 1:4600 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7031
Practice Address - Country:US
Practice Address - Phone:405-424-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist