Provider Demographics
NPI:1811187768
Name:ALLEN, SANDRA JAYNE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JAYNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JAYNE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:7218 S 90TH EAST AVE
Mailing Address - Street 2:APARTMENT 1073
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8230
Mailing Address - Country:US
Mailing Address - Phone:918-289-4806
Mailing Address - Fax:
Practice Address - Street 1:7218 S 90TH EAST AVE
Practice Address - Street 2:APARTMENT 1073
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8230
Practice Address - Country:US
Practice Address - Phone:918-289-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist