Provider Demographics
NPI:1497163695
Name:SCHRUNK, MADELINE JEAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:JEAN
Last Name:SCHRUNK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-7519
Mailing Address - Country:US
Mailing Address - Phone:405-414-5715
Mailing Address - Fax:405-722-3244
Practice Address - Street 1:6924 NW 112TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2976
Practice Address - Country:US
Practice Address - Phone:405-603-6622
Practice Address - Fax:405-722-3244
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist