Provider Demographics
NPI:1821483769
Name:BECKNER, ERICA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:BECKNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:WAUKOMIS
Mailing Address - State:OK
Mailing Address - Zip Code:73773-5400
Mailing Address - Country:US
Mailing Address - Phone:405-853-4305
Mailing Address - Fax:405-853-6106
Practice Address - Street 1:604 E OKLAHOMA ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1628
Practice Address - Country:US
Practice Address - Phone:405-853-4305
Practice Address - Fax:405-853-6106
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12106758235Z00000X
OK3510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist