Provider Demographics
NPI:1659580512
Name:GEDDES, SHELLY DEANN (MS)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DEANN
Last Name:GEDDES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MARYMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3948
Mailing Address - Country:US
Mailing Address - Phone:405-990-9417
Mailing Address - Fax:405-493-0717
Practice Address - Street 1:4331 ADAMS RD STE 111
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1007
Practice Address - Country:US
Practice Address - Phone:405-438-0090
Practice Address - Fax:405-493-0717
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114180Medicaid