Provider Demographics
NPI:1508248741
Name:BENNETT, BECKY (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4144
Mailing Address - Country:US
Mailing Address - Phone:918-808-2046
Mailing Address - Fax:918-493-7049
Practice Address - Street 1:7020 S YALE AVE STE 264
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5744
Practice Address - Country:US
Practice Address - Phone:918-493-7048
Practice Address - Fax:918-493-7049
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist