Provider Demographics
NPI:1811035900
Name:WRIGHT, SANDRA (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ELLEN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:1214 S LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-5122
Mailing Address - Country:US
Mailing Address - Phone:918-671-8310
Mailing Address - Fax:
Practice Address - Street 1:1214 S LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-5122
Practice Address - Country:US
Practice Address - Phone:918-671-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200246540AMedicaid