Provider Demographics
NPI:1558801654
Name:WEBB, DESIRAE (AUD)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 E. 68TH STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3356
Mailing Address - Country:US
Mailing Address - Phone:918-492-3636
Mailing Address - Fax:918-494-8915
Practice Address - Street 1:5020 E. 68TH STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3356
Practice Address - Country:US
Practice Address - Phone:918-492-3636
Practice Address - Fax:918-494-8915
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5455231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist