Provider Demographics
NPI:1821690678
Name:EASLEY, MIKLYNNE EMMY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIKLYNNE
Middle Name:EMMY
Last Name:EASLEY
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 1:510 E COMANCHE ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4522
Mailing Address - Country:US
Mailing Address - Phone:918-852-4227
Mailing Address - Fax:
Practice Address - Street 1:510 E COMANCHE ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4522
Practice Address - Country:US
Practice Address - Phone:918-852-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14338680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist