Provider Demographics
NPI:1649382375
Name:POWELL, LINDA CAROL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROL
Last Name:POWELL
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 1:204 NW MOCKINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-1625
Mailing Address - Country:US
Mailing Address - Phone:580-248-2099
Mailing Address - Fax:580-248-6530
Practice Address - Street 1:204 NW MOCKINGBIRD RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-1625
Practice Address - Country:US
Practice Address - Phone:580-248-2099
Practice Address - Fax:580-248-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK01088928OtherASHA ACCOUNT NUMBER