Provider Demographics
NPI:1528207586
Name:SELLERS, ANITA B (MS,CCC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:SELLERS
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 1:7762 S 92ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4916
Mailing Address - Country:US
Mailing Address - Phone:918-254-1955
Mailing Address - Fax:
Practice Address - Street 1:7762 S 92ND EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4916
Practice Address - Country:US
Practice Address - Phone:918-254-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK590SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist