Provider Demographics
NPI:1760173793
Name:VADEN, AYME DIANE (MS,CF-SLP)
Entity Type:Individual
Prefix:
First Name:AYME
Middle Name:DIANE
Last Name:VADEN
Suffix:
Gender:F
Credentials:MS,CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-0161
Mailing Address - Country:US
Mailing Address - Phone:918-413-3035
Mailing Address - Fax:
Practice Address - Street 1:30500 MAXEY CEMETERY
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966
Practice Address - Country:US
Practice Address - Phone:918-413-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist