Provider Demographics
NPI:1508451550
Name:BLACKWELDER, DEVYNNA GAYLE (SLP-A)
Entity Type:Individual
Prefix:MRS
First Name:DEVYNNA
Middle Name:GAYLE
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 SILVER CHARM LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2262
Mailing Address - Country:US
Mailing Address - Phone:405-595-7311
Mailing Address - Fax:
Practice Address - Street 1:6905 NW 122ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3903
Practice Address - Country:US
Practice Address - Phone:405-603-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA1852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant