Provider Demographics
NPI:1679129803
Name:SLOAN, TAMMIE LYN (BCBA)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYN
Last Name:SLOAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W MEMORIAL RD APT 421
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-6406
Mailing Address - Country:US
Mailing Address - Phone:405-394-4831
Mailing Address - Fax:
Practice Address - Street 1:1712 S POST RD STE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6614
Practice Address - Country:US
Practice Address - Phone:405-394-4831
Practice Address - Fax:405-610-5259
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-19-36368103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty