Provider Demographics
NPI:1689670077
Name:NGUESSAN, MARSHALL KRIZOA (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:KRIZOA
Last Name:NGUESSAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-3025
Mailing Address - Country:US
Mailing Address - Phone:580-658-2468
Mailing Address - Fax:
Practice Address - Street 1:1102 SE 36TH ST
Practice Address - Street 2:STE B
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8458
Practice Address - Country:US
Practice Address - Phone:580-351-2278
Practice Address - Fax:580-353-0462
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK305231H00000X
TX51685231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99841Medicare UPIN