Provider Demographics
NPI:1598186462
Name:HIGGINBOTHAM, CLINT
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 W GARY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3830
Mailing Address - Country:US
Mailing Address - Phone:580-275-2904
Mailing Address - Fax:
Practice Address - Street 1:1906 W GARY BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3830
Practice Address - Country:US
Practice Address - Phone:580-275-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK550237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist