Provider Demographics
NPI:1518604487
Name:SARGENT, LUCILLE (SLP)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 N COUNCIL RD APT 4104
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5607
Mailing Address - Country:US
Mailing Address - Phone:405-343-0414
Mailing Address - Fax:
Practice Address - Street 1:9201 S I 35 SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-9046
Practice Address - Country:US
Practice Address - Phone:405-601-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist